THE WRAPAROUND PROCESS: - Ohio



Welcome to

Hi-Fidelity

WrapAround Service Coordinator

Training

Sherri McKinney-Frantz, LSW

sherri01@

THE WRAPAROUND PROCESS:

THE GUIDING PRINCIPLES FROM THE U.S. NATIONAL

WRAPAROUND INITIATIVE

Overview of the WrapAround Process, Principles and Steps: The WrapAround process is a way to improve the lives of children with complex needs and their families. It is not a program or a type of service. Communities to support children with complex needs and their families by developing individualized plans of care use the process. The key characteristics of the process are that the plan is developed by a family centered team, is individualized based on the strengths and culture of the child and their family, and is needs rather than services driven.

The U.S. National WrapAround Initiative has standardized ten guiding principles:

1. Family Voice and Choice

2. Team Based

3. Natural Supports

4. Collaboration

5. Community Based

6. Culturally Competent

7. Individualized

8. Strengths Based

9. Persistence

10. Outcome Based

The family are integral parts of the team and must have ownership of the plan. No planning sessions occur without the presence of the family. This principle is referred to as Family Voice and Choice. A WrapAround team, who consist of the family and the three to seven people who care and know the child and family best, develops the actual individualized plan. The team is selected by the family and typically has no more than half professionals. The team represents the principle of Team Based. The individualized plan is child-centered and family-focused with maximum family involvement, with variation depending on the needs of the child and family. The process focuses on strengthening the natural family, extended family and social supports for the child by involving them in the planning and implementation process. These social supports represent the principle of Natural Supports.

Many families who are served through the WrapAround process have needs, which have traditionally been met by more than one services system or schools. These services systems and schools agree to the principle of Collaboration, working together and moving to Integration where all parties work in a team with the family and design and implement one plan. Services and supports are based on the principle of being Community-based. When residential treatment or hospitalization is accessed, these service modalities are to be used as stabilization resources and not as placements that operate outside of the plan produced by the child and family team. All services and supports must be based on the principle of being Culturally Competent. That is to say, services and supports must be tailored to the unique culture of the child and family. Family culture refers to family race and ethnicity as well as family habits, preferences, beliefs, language, rituals, and dress, based on “one family at a time”.

The principle of true Individualization is at the heart of the WrapAround process. Each child, youth, and family has an individualized plan. The plan may include services (such as therapy or day treatment) that other plans have included but when they do include these more typical services, the team always evaluates and understands why the service is a precise match for the unique needs of the child, youth, and/or family. The plan is structured around the principle of Strengths Based, where the plan is based on the unique strengths, needs, values, norms, preferences, and culture, and vision of the child, family, and community. No interventions are allowed in the plan unless they have matching child, family, and community strengths. By building on these strengths, the plan supports who the child is and how the child will positively progress in life. The plan is focused on typical needs in life domain areas that all persons (of like age, sex, culture) have. These life domains are: independence, family, living situation, financial, educational, social, recreational, behavioral, emotional, health, legal, cultural, safety, and others.

The child and family team and agency staff that provides services and supports must make a commitment to the principle of Persistence in delivery of services and supports. When things do not go well, the child and family are not “kicked out”, but rather, the individualized services and supports are changed. Planning, services, and supports cut across traditional agency boundaries through multi-agency involvement and funding. Governments at regional and local levels work together with providers to improve services, and commit to the final principle of being Outcome Based. Both system of care issues and issues of individual plans are considered. Outcome measures are identified and individual WrapAround plans are frequently evaluated. The collaborative funders of services agree to focus funding on efforts like WrapAround, which have solid evidence for effectiveness.

Phases of WrapAround Practice

From the U.S. National WrapAround Initiative

The new U.S. National WrapAround Initiative has developed the concept of phases of WrapAround practice, to describe the overall tasks of the process:

Phase One: Engagement and Team Preparation. During this phase, the groundwork for trust and shared vision among the family and WrapAround team members is established, so people are prepared to come to meetings and collaborate. This phase, particularly through the initial conversations about Strengths, needs, culture, and vision, sets the tone for teamwork and team interactions that are consistent with the WrapAround principles. The activities of this phase should be completed relatively quickly (within 1-2 weeks if possible), so that the team can begin meeting and establish ownership of the process as quickly as possible.

Phase Two: Initial Plan Development. During this phase, team trust and mutual respect are built while creating an initial plan of care using a high quality planning process that reflects the WrapAround principles. In particular, youth and family should feel, during this phase, that they are heard, that the needs chosen are ones they want to work on, and that the options chosen have a reasonable chance of helping them meet these needs. This phase should be completed during one or two meetings that take place within 1-2 weeks; a rapid time frame intended to promote team cohesion and shared responsibility toward achieving the team’s mission or overarching goal.

Phase Three: Implementation. During this phase, the initial WrapAround plan is implemented, progress and successes are continually reviewed, and changes are made to the plan and then implemented, all while maintaining or building team cohesiveness and mutual respect. The activities of this phase are repeated until the team’s mission is achieved and formal WrapAround is no longer needed.

Phase Four: Transition. During this phase, plans are made for a purposeful transition out of formal WrapAround to a mix of formal and natural supports in the community (and, if appropriate, to services and supports in the adult system). The focus on transition is continual during the WrapAround process, and the preparation for transition is apparent even during the initial engagement activities.

What is a WrapAround Service Coordinator?

There have been many terms to describe the title of the person who makes the WrapAround process happen for an individual family, including case managers, care coordinators, service coordinators, wrap assistants, system navigators, family support specialists, etc. We use the term WrapAround Service Coordinator in this training. A WrapAround Service Coordinator is a person who ensures that the values and steps of the process are delivered with the highest possible fidelity to national best practices as possible, while still allowing for local individualization of the process.

The Service Coordinator is not just a neutral coordinator of services but someone who brings added value to the table. The WrapAround Service Coordinator helps the family to develop a pro-social narrative as part of the strengths, needs and culture discovery. The WrapAround Service Coordinator teaches and supports the family to learn and use the skills to develop their own plans and access their own resources. The WrapAround Service Coordinator works with the family to build and strengthen their natural support network. The WrapAround Service Coordinator develops a partnership relationship with the family that helps them to address and work through challenges to make changes in their lives. This may include understanding developmental readiness and using teachable moments to surface issues that are important to helping the family reach their long-range vision.

Qualifications. A WrapAround Service Coordinator should have a broad base of experience with life and possess a diverse view of what families need to have better lives. The ideal Service Coordinator has experience working directly with children and their families in a variety of settings, or living with children who have complex emotional needs. The ideal Service Coordinator is able to work under supervision and collaborate closely with a team of family members, natural supports and professionals who develop and carry out individualized plans. A preferred Service Coordinator characteristic is an understanding and experience with different systems, including schools, mental health, child welfare, juvenile justice, health, and others. Another preferred characteristic is knowledge of community resources and an ability to engage these.

WrapAround Service Coordinator caseloads and best practice. Typically, to produce a high fidelity WrapAround process as described in this training, a Service Coordinator can facilitate between 8 and 15 families. To manage this number, all families cannot start the process at the same time, as the early weeks with the family are more time consuming.

Characteristics of Effective Service Coordinators

• Outgoing personality

• Ability to understand from another’s point of view

• Sense of humor

• Detail management and follow through

• Life experience just as important as academic learning or degrees

• Self-awareness (of potential “blind spots”)

• Knowledge of other child-serving systems

• Ability to suspend our personal culture and judgment

• Willingness to show our human-ness, i.e., appropriate self-disclosure

• Know when to seek supervision and/or clinical input

• Mobilizes team to implement plan – doesn’t take on too much

Activity:

Personal Strengths in Area of WrapAround Service Coordination

Pairs Exercise

Instructions:

1. After your trainer gives the signal, take two minutes and write down your strengths that will support you in your role as a WrapAround Service Coordinator.

2. What characteristics of the effective Service Coordinator are possible areas of development or need for you?

Phases and Activities of the WrapAround Process*

The table presented here, and in each new section of materials on skills represents the results of a research project intended to clarify the types of activities that must be included in a full WrapAround process. Each table identified as being from the National WrapAround Initiative is followed by a table of discrete skill sets developed by Vroon VanDenBerg as part of a WrapAround credentialing process. This information is one component among a set of materials that has been produced as a result of the National WrapAround Initiative, an endeavor that strives to better operationalize and define this important and innovative model for working with families. The set of materials also includes a description of the principles of WrapAround, a description of the organizational and system conditions needed to support a high-quality WrapAround process, a glossary of terms, and other documents still under construction. Some of the documents still being completed include youth, family, and team member handbooks, fidelity measures, and a compilation of tools and procedures to support the process described here. This multi-dimensional description of the WrapAround process represents the culmination of an extended process of compiling materials, synthesizing them, and getting quantitative and qualitative feedback from the initiative’s Advisory Group.

In the case of the current description of the activities of WrapAround, descriptions of WrapAround models were compiled from training manuals, monographs, operating procedures of successful WrapAround programs, and interviews with WrapAround trainers, family members, and family advocates. We then created an initial description of the phases and activities and provided it to 10 WrapAround innovators and prominent family advocates nationally for in-depth feedback. After revision to reflect the results of these interviews, the document was presented to Advisory Group members and quantitative feedback was provided through a Delphi process that asked them to vote on (1) whether the activities presented were “essential, optional, or inadvisable” and (2) whether the wording of the activities was “fine, so-so, or unacceptable.” Qualitative feedback included specific suggestions for revising content and wording. An extensive revision based on the quantitative and qualitative feedback was then undertaken again.

The resulting “Phases and Activities of the WrapAround Process” focuses on what needs to happen in WrapAround; however, how the work is accomplished is equally important. Merely accomplishing the tasks is insufficient unless this work is done in a manner consistent with the 10 principles of WrapAround. In addition, future work from the National WrapAround Initiative will focus on providing more detailed information about team member skills that are necessary for the WrapAround process, as well as descriptions of specific procedures, templates, and other tools that can be used to complete the activities described here. Finally, it should be stressed that even the basic description presented here remains a “living document” that will be updated based on pilot testing and feedback from an even broader audience of reviewers than has participated thus far.

* Bruns, E.J., Walker, J., VanDenBerg, J. Rast, J., Osher, T.W., Miles, P., Adams, J., & National WrapAround Initiative Advisory Group (2004). Phases and activities of the WrapAround process. Portland, OR: National WrapAround Initiative, Research and Training Center on Family Support and Children’s Mental Health, Portland State University

WRAPAROUND PRACTICE ELEMENT: ENGAGEMENT

Engaging families who may not want to work with you.

Instructions: Trainer will read scenario, underline areas of concern for the family. Discuss effective strategies the Service Coordinator can used to engage the Locke family

Scenario. The Locke family has been referred to WrapAround by the local child welfare office. Child welfare substantiated neglect when their middle school age children repeatedly showed up at school dirty and hungry. The family has had over 12 years of contact with child welfare and four out of five children have ended up deeply involved in the juvenile justice system. The parents have never had a child permanently removed, but it has been close many times. The parents live in a very dilapidated house surrounded by junk cars and refuse. They have been in a permanent battle with city inspectors and are now under court order to clean up the property. They are cooperating with child welfare at minimal levels, and know the tricks of doing just enough to avoid permanent removal of the children. They have had over 25 different caseworkers over the last 12 years.

The most relevant definition of “engagement” from Webster’s is: “contact by fitting together”; "the meshing of gears". The gears of a clock function well only in perfect partnership. If they do not fit precisely, the clock will not keep accurate time or will not operate at all. A WrapAround Service Coordinator’s successful engagement with a child and family also requires care if there is to be a successful partnership that leads to desired outcomes.

Other helping disciplines use different words to describe the process of engagement with the family. Family therapy refers to “joining”. Others refer to the process of “establishing rapport” or “establishing a therapeutic alliance”. Despite the varied language, all helping disciplines emphasize the importance of developing trust in the helping relationship. All disciplines also emphasize that effective engagement is based on personal attributes including empathy, genuineness, and respect.

The engagement process begins with the Service Coordinator’s initial communication to the child and family. Often this initial communication is a phone call. Service Coordinators who can clearly and briefly explain the WrapAround process without using system or professional jargon foster effective engagement during this phone call. During the phone call, the Service Coordinator also sets a meeting with the family at a time and place of the family’s convenience to continue engagement in-person and encourages the participation of as many family members who would like to attend this meeting.

The purpose of the initial “in-person” meeting is to get to know the child and family. Active listening is very important in this engagement meeting to the extent the family wishes to share their story. Paperwork should be kept to a minimum. The engagement meeting is a conversation – not an interview. Careful listening during the engagement meeting will often result in the early identification of primary family needs, their long term vision, and potential short term goals which become the target of the WrapAround plan. The Service Coordinator simply makes mental or written notes of needs, long-term vision, and short-term goals and is careful not to prematurely move to solutions.

The process goal of the engagement meeting is to further the development of trust and for the child and family to experience active listening. The Service Coordinator will also explain the strengths, needs and culture discovery interview meeting. Finally, the Service Coordinator begins or sets a time and location for the strengths, needs and culture discovery meeting with the family, and encourages participation of other extended family members and other people who wish to attend the discovery meeting.

For children and families who have had many negative experiences with helping professionals or non-collaborative systems, the engagement process may be slow and lengthy. Take care not to view this as the “fault” of the child and/or family, but rather as their unique characteristics. Consistent and mindful attention to engagement with the child and family over several weeks may be required before there a minimum level of trust is established. For many children and families, the first glance of the WrapAround process may seem like “same old same old.”

Once the family begins to understand the WrapAround process, they often report that this is the first time that professionals have asked them what they need and truly meant it, with the question backed up by resources and staff time. Engagement is an ongoing process not an event. Eventually, the majority of child and families do engage and become true partners in the WrapAround process.

It is important to understand that the steps of the WrapAround process may be done out of written sequence. For example, it is common for a family member to state a long-range vision early in the engagement session. The Service Coordinator should record this, and attend to it in the future.

Key Components of the Engagement Process.

• Establish trust through active listening

• Educate the child and family about the role of the WrapAround Service Coordinator and the child and family team process

• Identify the child and family’s hopes and dreams, i.e., what do they need to have a better life?

Engagement: First Steps

How do we go about making contact and forming working partnerships with a family? Sending and receiving messages that effectively connect one person to another requires a process of exchange that allows for full acknowledgment of the other person, sharing understanding with that person and having a positive influence on each other. WrapAround requires the skills that make such a relationship succeed. The skill is called “Engagement”.

Engagement, in our work, has the intent of drawing those we serve into meaningful, often life changing activities, by employing their thoughts and efforts productively, while involving ourselves in a like manner. We engage families and individuals to achieve the goals of safety, permanence and well-being. We engage to develop and maintain a working partnership between us and the child, adult, and family. It is not possible to engage someone on such a meaningful level without having him or her feel cared about, even if they don’t admit it or respond to our caring in positive ways. Our goal in the relationship is to develop trust, openness and honesty. We cultivate awareness that each person has unique strengths that they can apply to solving the issues at hand. Through our efforts we demonstrate that their needs are worth our focused attention and action. When we are rejected, we continue to hold out the offer to engage.

Foundational Principles of Engagement

Genuineness is “being you,” being congruent in what you say and do, being non-defensive and spontaneous. To be genuine you need to be aware of your feelings and at the same time respond to the family member in a respectful manner that opens up rather than closes communication. Genuineness helps to reduce the emotional distance between you and the family member and helps the family member to identify you as another human being similar to him/herself. You can demonstrate genuineness by:

▪ Being yourself and balancing this with your professional role, and acting consistent with how you feel or believe

▪ Making sure that your nonverbal behavior, voice tone and verbal responses match or are congruent

▪ Communicating trustworthiness and acceptance

▪ Being able to express yourself naturally without artificial behaviors

▪ Being non-defensive

▪ Self-disclosing in a purposeful and brief manner

Respect is believing that there is value in each human being and that there is potential in that person as well. There are two aspects of respect: 1) your attitude or value about people and 2) your ability to communicate respect in observable ways. Respect involves valuing the family member as a person, separate from any evaluation of his/her behavior. Respect is recognizing the dignity and worth in each human being. When communicating respect, there is warmth that is conveyed to people that says you accept them, you like them, you care about them and you have concern for them. Respecting a person does not mean sanctioning or approving his/her thoughts or behaviors of which society may disapprove. Values and beliefs that convey respect include belief in the following: all human beings are worthy; each person is a unique individual; people have the right to self-determination and to make their own choices and people can change. Respect can be communicated and demonstrated by:

▪ Communicating warmth

▪ Showing commitment

▪ Recognizing a person’s strengths

▪ Being open-minded

▪ Using a person’s strengths

Empathy is a process in which you attempt to experience another person’s world then communicate an understanding of and compassion for the person’s experience. You develop a sense of what the situation means to the other individual. Empathy is being able to see through another’s eyes and understand their world view. The two-step process involved in demonstrating empathy is:

▪ Recognizing the person’s experience, feelings and nonverbal communication

▪ Communicating with words your understanding of the person’s experience. Your communication will reflect your understanding of their ideas and feelings. Accurate empathy helps create a climate where the family member is willing and able to explore his/her issues and problems. Communicating with empathy results in more openness in people.

CAUTION!!! Most of us were trained to quickly assess, diagnose or make conclusions about needs, and provide solutions. One of the most common errors that new Service Coordinators can make is to begin to provide solutions, not realizing that to the families, they are strangers. The job of the WrapAround team is to create solutions (aka options or strategies), and the Service Coordinator who begins to jump in with solutions during engagement jeopardizes the potential positive outcomes of the WrapAround process.

Activity

Instructions:

1. In your group, read the following information about Angela and Kelly.

2. One of the group members should assume the role of Angela and one that of Kelly. (If Kelly shows good engagement skills, Angela should give a little. If not, Angela should keep in a self-protection mode.)

3. When Kelly shows either positive or less effective skills, briefly freeze the role play as demonstrated and record the specific skill on the following recording sheet.

4. Note one top positive engagement strategy to share with the large group

Angela -

⇨ You are 28 and living with Phillip.

⇨ You are divorced from the girls’ father, Larry, and would rather they not see him, but you know what it’s like to grow up without a Dad.

⇨ You know you have a temper, but are proud that you stand up for yourself and you are proud to be with a man who is not on drugs and doesn’t hit you like your ex-husband did.

⇨ You do miss Victoria and you want her to come home.

⇨ Sometimes you just get stressed about work and the school calls because Victoria’s misbehaving and you’re tired and you thought you didn’t need your meds this week and you just either decide to treat yourself to some drinks or you might just blow up.

⇨ Sometimes you lose it with Phillip, but don’t hit him very hard and pride yourself on not hitting the girls.

⇨ Your dominant feelings initially are exhaustion and hopelessness. You feel you have tried hard to comply with the demands made of you but feel overwhelmed. How could anyone work full-time, take your of your own problems, take care of the children, and make all of the appointments that are required. Unless the Service Coordinator identifies these feelings and is compassionate, you will reply to questions with “I don’t know.” Or “I guess I’m just not a very good mom.”

⇨ The skillful Service Coordinator will explain that the Service Coordinator role and the role of the CFT to provide support. Your response to the team once it is described is to say that you don’t have any family or friends besides Phillip who you would want on the team. Nonetheless, if the Service Coordinator explains this well, you are willing to give it a try because you want you children back, and you have nothing to lose at this point.

⇨ You don’t like your case worker Irma very much. You feel she is bossy. Nonetheless, the Service Coordinator needs to be a truth-teller and you appreciate it he or she matter-of-factly can summarize what was learned in the meeting with Irma. It is especially important for the Service Coordinator to review the priority areas of concern from the child welfare perspective as they are reflected in the case plan. The skillful Service Coordinator will do this in a neutral way – without blaming or shaming. If he or she does this sensitively, you will largely agree that they are legitimate concerns.

⇨ Your other concerns, those not identified on the case plan, include: not having any women friends you can confide in, and not having enough time and energy to get everything done in the house and with the children.

Kelly – Service Coordinator

⇨ You are the mental primary Service Coordinator for the WrapAround planning process.

⇨ You have one year experience as a WrapAround Service Coordinator and enjoy your job.

⇨ Your supervisor is very supportive but also worries about Angela’s ability to carry out a positive plan.

⇨ Your intent is to work closely with Irma (CPS worker) to ensure care coordination functions are completed without significant duplication of efforts.

⇨ You have been working with the family since their referral. You have met with Irma and she has provided you with information about the past history and current status of the family.

⇨ You have met with Victoria once.

Today is June 1, 2007

Angela is a 28-year old mother of two girls - Victoria, age 5 who is currently living in the foster home of Delta Foster and Victoria’s younger sister, Elizabeth (age 3). Elizabeth continues to reside at home with her biological mother, Angela Hardy and her boyfriend, Phillip Dixon. Angela is divorced from Victoria and Elizabeth’s father, Larry Hardy and he has visitation with the girls. Angela and Larry have had their rights terminated with regard to two other children (8 and 9) who have subsequently been adopted and moved out of state.

Child Welfare became involved with Victoria and Elizabeth in August 2005 due to reported domestic violence in the home on the part of both Mom and Dad. The home was found to be dirty and in extreme disarray. No abuse was substantiated and the parents were referred to domestic violence counseling. In December 2005, a referral alleging neglect of the girls was substantiated and found to be drug related. The case was referred to Family Preservation and the parents began and received services for approximately three months, but then discontinued services. Subsequent to learning that her children may be removed, Angela kicked Larry out and resumed cooperating with in-home services. Angela and Larry divorced and he maintains visitation with the girls. Angela made progress and maintained a steady job and the case was closed in April 2006. In December 2006, a referral was investigated regarding the girls’ condition on arriving at daycare and Victoria’s increasing aggression toward her teacher and peers. The home was again found to be dirty and in extreme disarray and neglect was substantiated. In April 2007, the case worker reported that Victoria’s behavior was unmanageable and Victoria was found not to be receiving her meds consistently and as prescribed. Neglect was substantiated and Victoria was removed from the home and placed into the foster home of Delta Foster.

Angela has been diagnosed with an intermittent explosive disorder and has received counseling from a local mental health therapist and medication management from a psychiatrist. She has participated in anger management and parenting classes and received instruction in housekeeping, budgeting and time management. Victoria has received counseling from a local mental health therapist and medication management by a child psychiatrist.

The caseworker (Irma) talked to Angela about WrapAround and Angela said she would like to hear more about it. The Service Coordinator (Kelly) first visited the home unannounced, as the phone had been disconnected. The environment was chaotic. Adults were coming and going from the home during the visit. Elizabeth and the other children present were loud and quite active. The children looked unattended to and were not responsive to adult requests. The Service Coordinator expressed her desire to concentrate on what Angela had to say and asked her if someone in the home could watch Elizabeth while they stepped outside to talk. The Service Coordinator explained that she represented a service in the community that helped parents that were having difficulty with their children.

Angela responded that she was concerned that strangers, who didn't understand her situation, would be so "nosy". The Service Coordinator acknowledged that this must be disturbing to Angela and that she would have a similar response if she were in Angela's situation. The Service Coordinator told Angela that she had helped many families and that they often felt the same way, at first. She then asked Angela if she would give her a chance in assisting her to make the changes her family needed. She then affirmed that Angela had been able to keep her children close to her and that, with the little observation she had made already, they seemed to look to her for safety and support.

Angela said that she needed help but did not know how to change her circumstances. In response, the Service Coordinator asked Angela what she thought would happen if things stayed just the way there were now and how things would be a few years from now if nothing changed. Angela said she never really thought about things too far into the future - but she did want to be a better mother. The Service Coordinator said she believed Angela. She then asked Angela when she had first decided that she needed to improve as a mother and what were the things that she wanted changed in her life?

This small example shows three foundational principles of engaging - genuineness, empathy and respect. The Service Coordinator (Kelly) approached Angela offering honest concern and sincere help. She was genuine. She acknowledged the discomfort Angela must feel in having a stranger enter her personal life. She showed empathy. She accepted that Angela wanted to improve her situation and that she also wanted to be successful with her children. She showed respect. This may sound very simple. It is simple when the skills of engagement are used consistently, effectively and purposefully. The goal is to establish and keep a productive relationship centered on the issues that the family needs to resolve. The skills of engaging can effectively establish the Service Coordinator as someone who can help and be trusted.

Among the important skills of good engagement are information gathering through active listening, clarification, reframing, and questions, and focusing through reflection and summarization (see the definitions of these and you may want to determine which ones were used by the Service Coordinator in the short example).

Information Gathering

Active Listening – and the use of reflections. Listening is an active process which requires you to focus on what the family member is saying both in the content of his/her message and in the emotional process of his/her message. It is the most powerful interpersonal helping skill that promotes rapport and the building trust and engagement. Active listening involves using both verbal and nonverbal messages to communicate your understanding of the family’s experience. Your verbal response can focus on what the person is describing, how the person is feeling or both. You can reflect what the person is saying and/or reflect what the person is feeling. Active listening is used to empower families to explore and discuss topics. It conveys your understanding of their situation. It can help you gather certain information and it develops a broader and deeper understanding of the person’s circumstances.

Attending Behaviors. These are behaviors that convey respect, acceptance and trust to family members. Following are two categories of attending behavior:

▪ Physical attending uses the environment and body to demonstrate respect for, acceptance and interest in the family member. You want to create a comfortable environment absent of distractions. You want to assure open communication by not placing any barriers between you and family members.

▪ Psychological attending involves observing and listening to the family member and responding. It involves observing the person’s nonverbal behavior, hearing what the person’s voice communicates and assessing the congruence between the person’s words and behaviors. Examples of verbal following and minimal encourages are, “Oh, can you tell me more?” and, “Um-hmm,” and, “Really?”

Clarification. Clarification is a process you use to help family members develop an understanding and awareness of their feelings, thoughts and behaviors. Clarifying responses facilitate the development of the family member’s awareness and understanding of himself/herself.

Reframing. Reframing is helping the person change his/her frame of reference in such a way that the problem can be approached in a positive way. It refers to the process of assisting the family member in identifying a different framework for understanding and responding to a problem. For example, we can view change as painful or frightening, or we can reframe change as manageable stages leading to a new opportunity.

Questions. Effective communication involves combining different types of questions. Questions should be used carefully and sparsely. Questions are a way for the WrapAround Service Coordinator to focus a conversation.

▪ Open-ended questions are used to encourage communication, gather information and explore issues. Family members can answer as they choose, giving them an opportunity to explore their thoughts, feelings and experiences. Questions starting with the words how or what encourage the person to explore and allow him/her to express his/her own feelings, views and perceptions.

▪ Closed-ended questions are used to gather specific factual information. Closed questions begin with the words who, when, will, is or where and usually can be answered with a one- or two-word answer.

▪ Indirect questions are statements that imply a question. Indirect questions can begin with, “Tell me. . .” or, “I’ve been wondering. .” Indirect questions can be used to explore sensitive subjects and can lessen the harshness of a series of questions.

Solution-focused questions are used to move from reframing to solutions. Solution-focused questions empower families to find their vision of success and their own strategies that have worked or will work for them. Solution-focused questions can be used to define the problem, determine when the problem does not exist and encourage the family to specify what they do want.

ADDRESSING LEGAL AND ETHICAL ISSUES

|From the National WrapAround Imitative: |

|1.1 b. Address legal |1.1b. Address legal and ethical issues. Service Coordinator reviews all consent and release forms with the family |

|and ethical issues. |and youth, answers questions and explains options and their consequences. Service Coordinator discusses relevant |

| |legal and ethical issues (e.g. mandatory reporting), informs family of their rights, and obtains necessary |

| |consents and release forms before the first meeting |

|From the Vroon VanDenBerg Skill sets |

|1.1 b. Address legal|The Service Coordinator explains client confidentiality and client/families rights and responsibilities in these |

|and ethical issues. |areas. |

| |The Service Coordinator answers the family’s questions in the above areas |

During the initial meeting with the family it is important to explain legal and ethical issues. This includes the role of confidentiality and how information is protected. The process for sharing information is also discussed. During these discussions the Service Coordinator should emphasis that there can be benefits from information sharing but that the decision to allow information sharing is the family’s. Once this process has been described, the Service Coordinator should explain the consent forms and get these completed. This should be the only forms that are completed during this initial meeting but it is important to get these done now so the Service Coordinator can gather information to help with the strengths needs and culture discovery and follow-up with the referral source and other current service providers.

The Service Coordinator should also explain their role as a mandatory reporter. Families need to know about this up front and if presented in the spirit of the engagement activities that have been completed on the previous sections, should be informative for the family. Families will be told that they will be included in the process of reporting potential harm when and if it happens.

IMMEDIATE CRISIS STABILIZATION

|From the National WrapAround Initiative: |

|1.2 Stabilize Crises |1.2a. Ask Family about immediate crisis concerns. Service Coordinator elicits information from the |

|Goal: To address pressing needs |family and youth about immediate safety issues, current crises, or crises that they may anticipate might|

|and concerns so that family and |happen in the very near future. These may include crises stemming from a lack of basic needs (e.g., food|

|team can give their attention to |and shelter) |

|the WrapAround process. | |

|From the Vroon VanDenBerg Skill Sets: |

|(VVDB has added functional assessment as a critical part of eliciting information and using the information to help stabilize the crisis|

|situation.) |

|1.2 a. Ask family and |The Service Coordinator asks the family about immediate crisis or and safety concerns. If any are identified, |

|youth about immediate |the Service Coordinator does a quick functional assessment on the crisis or safety concerns. |

|crisis concerns. |The Service Coordinator helps the family and youth to recognize which concerns need immediate attention and |

| |which concerns can wait until the team convenes. |

As the Service Coordinator gets to know the child and family during the engagement process, the second task of the Service Coordinator is to stabilize any immediate safety issues or crisis issues. No person in great stress or who is concerned about personal or family safety can enter fully into an important relationship or begin the strengths needs and culture discovery part of the WrapAround process. Therefore, the Service Coordinator directly asks the family if there are any immediate safety or crisis concerns.

Safety and crisis concerns may take many forms but the two most frequent are concerns about the safety of a child being in a potentially unsafe environment and concerns the child may do something that puts others in jeopardy. If other systems are involved (e.g. child welfare, juvenile justice, or education) they may have already developed a safety plan. Even if they have not, they will want to know about the plan and may want input.

The Service Coordinator is more directive during this stage of the WrapAround process if there is a significant crisis or safety issue that needs immediate attention. The Service Coordinator should elicit as much information as possible about the nature of the potential crisis and the specific safety concern. The Service Coordinator’s role at this juncture is to mobilize all necessary resources to ensure that the safety concern is fully addressed, so the family will stabilize. Specific steps for crisis and safety planning will be taught later in the training.

Functional Assessment

Successful service and support plans that target changing challenging behavior are more likely to be developed after the Service Coordinator has gained a comprehensive understanding of the behavior and the context within which the behavior occurs. Understanding the behavior and context of the behavior maximizes the potential that plans will effectively address underlying needs, interrupt repeating sequences of undesirable behavior and/or reinforce and amplify desired behaviors. This process of gaining deep understanding of a challenging behavior and its context is called a functional assessment.

Well developed functional assessment skills are important for the WrapAround Service Coordinator because a functional assessment is a necessary component of several steps of the WrapAround practice model. Specifically, a functional assessment may be necessary if there is a need for Immediate Crisis Stabilization. Functional assessment is always a component of WrapAround Plan Development and Crisis Planning.

A functional assessment can only be completed by gathering descriptive information from those who understand and know the behavior the best. This usually means interviewing the child, siblings, the parents, other extended family members, other natural supports, the clinician if involved, or other system partners such as child welfare workers, teachers or probation officers.

The functional assessment process may seem like a return to deficits. It is not shaming or blaming but factual information gathering. The plan is developed based on the understanding gleaned from the assessment built on child and family strengths and family culture.

Key Components of the Functional Assessment

1. Define the behavior.

• In a few simple sentences describes the behavior of concern

• Be specific enough that everyone on the team will recognize it if it occurs.

2. What happens before the behavior?

• What are the triggers?

• When does the behavior occur?

• Look for exceptions. The brief strategic school of systemic therapy and behaviorists remind us to find out about time when the challenging behavior DOES NOT occur. What’s different about these times? What triggers the behavior to NOT occur? Or striving for better grammar, what triggers the alternative behavior we would like to see occur more frequently?

3. What happens during the behavior?

• What happens specifically? Who does what?

• How often does the behavior occur?

• How long does it last?

4. What happens after the behavior?

• What are the consequences of the behavior? How do people feel afterward?

• Does the behavior result in the child getting something or doing something

he/she wants to do?

• Does the behavior result in the child not doing something?

5. What’s the best guess as to why the behavior is happening?

This element of the functional assessment involves suggesting hypotheses for what need is being met by the behavior. Get key informants best guesses on this and select the one that is most plausible.

6. Select a positive replacement behavior.

This part of the functional assessment involves looking at strengths, culture, and vision to identify a positive behavior to serve the same function as the problem behavior.

See the following page for a sample Functional Assessment

| |

|Sample Functional Assessment |

|WrapAround Service Coordinator:_________ Date: ___________ Family:__________ |

|Step |Question/Answer |

|1 |Clearly describe the behavior: |

| |Bob refuses to comply with his parent’s request, throws nearby objects, puts family or others at risk, and does not seem |

| |to be able to control the behavior. |

|2 |What happens before the behavior occurs (triggers)? Are there times/situations where the behavior does not occur? Why? |

| |His parents will make a simple request about any number of things they want him to do. Sometimes this is a request to do |

| |something and sometimes it is a request to stop. |

| |He is more likely to do this with changes in routines. |

| |He is more likely to do this when he has consumed sugar or caffeine |

| |He is more likely to do this when he has not slept well the night before. |

|3. |What happens during the behavior? |

| |When Bob starts the behavior his parents try to reason with him. After several attempts he may escalate to more intense |

| |yelling or aggression. His parents will sometimes try to force him to do the thing and he will often seem to lose |

| |control at this point. |

|4 |What happens after the behavior occurs? |

| |When Bob starts the behavior his parents try to reason with him. After several attempts he may escalate to more intense |

| |yelling or aggression. His parents will sometimes try to force him to do the thing and he will often seem to lose |

| |control at this point. In the end they often back off until he calms down and then try again later (or not at all). |

|5 |Best guess about why the behavior occurs? |

| |Parents feel that Bob is able to successfully avoid following instructions he does not want to do. He also uses the |

| |behavior to control his parents and does so very successfully. |

|6 |Select a positive replacement behavior |

| |Bob will express his choice verbally and will negotiate choices acceptable to him and his parents. |

Crisis Stabilization Plan

|From the National WrapAround Initiative: |

|1.2 b. Elicit information |1.2 b. Elicit information from agency representatives and potential team members about immediate crises or |

|from agency representatives|potential crises. Service Coordinator elicits information from the referring sources and other knowledgeable |

|and potential team members |people about pressing crisis and safety concerns |

|about immediate crises or | |

|potential crises. | |

|From Vroon VanDenBerg Skill Sets |

|1.2 b. Elicit information |The Service Coordinator determines if referral and custodial agencies have immediate crisis or safety |

|from agency representatives |concerns. |

|and potential team members | |

|about immediate crises or | |

|potential crises. | |

As the Service Coordinator gets to know the child and family during the engagement process, the second task of the Service Coordinator is to address any immediate crisis or safety issues. No person in great stress or who is concerned about personal or family safety, can enter fully into an important relationship or begin the strengths, needs and culture discovery part of the WrapAround process. Therefore, the Service Coordinator directly asks the family if there are any immediate crisis or safety concerns.

Crisis and safety concerns may take many forms but the two most frequent are concerns about a child being in a potentially unsafe environment and/or concerns the child may do something that puts others in jeopardy. If other systems are involved (e.g. child welfare, juvenile justice, or education) they may have already developed a safety plan. Even if they have not, they will want to know about the plan and may want input.

The Service Coordinator is more directive during this stage of the WrapAround process if there is a significant crisis or safety issue that needs immediate attention. The Service Coordinator should complete a functional assessment of sufficient comprehensiveness so that an effective stabilization plan can be developed. The Service Coordinator’s role at this juncture is to mobilize all necessary resources to ensure that the crisis or safety concern is fully addressed, so the family will stabilize.

Activity:

Crisis Stabilization

Pairs Role Play: Go back into the role play groups. Switch roles of Angela and Kelly.

Setting the stage for the role play:

⇨ As needed, review or reread the initial engagement example with Angela to identify potential crisis and safety issues. Currently the permanency plan has established foster care as a safety plan for Victoria.

⇨ The caseworker (at referral) told Kelly that she was, overall, pleased with Angela’s and Phillip’s progress toward reunification. But, she said that she was very worried about the upcoming unsupervised visit, and that she saw a risk that Angela could escalate, perhaps get too loud, scream, etc. If Victoria was frightened or re-traumatized, the caseworker would have to implement the concurrent plan and look at permanent removal, and remove the three year old.

⇨ Kelly’s tasks are to a.) Review Angela’s strengths/assets in dealing with crisis, b.) get Angela’s permission to address the caseworker’s predicted crisis, including doing a functional assessment, c.) Work with Angela to create a strengths-based, culturally competent band-aid plan for the unsupervised visit, which is coming up in two days.

The Service Coordinators’ Goals: For the role play you have three goals:

1. Identify potential crisis situations.

2. Do a functional assessment of the challenging behavior identified by the family.

Use the Functional Assessment Form on the next page to structure this task.

3. Based on the functional assessment information, develop a temporary stabilization

plan that adequately addressed the challenging behavior and associated risk. This

is not the WrapAround plan or the plan for the prevention of ongoing crisis. We

will share in large group as time allows…

| |

|Sample Functional Assessment |

|WrapAround Service Coordinator:_________ Date: ___________ Family:__________ |

|Step |Question/Answer |

|1 |Clearly describe the potential crisis behavior: |

| | |

| | |

| | |

|2 |What happens before the behavior occurs (triggers)? Are there times/situations where the behavior does not occur? Why? |

| | |

| | |

| | |

|3. |What happens during the behavior? |

| | |

| | |

| | |

|4 |What happens after the behavior occurs? |

| | |

| | |

| | |

|5 |Best guess about why the behavior occurs? |

| | |

| | |

| | |

|6 |Select a positive replacement behavior |

| | |

| | |

| | |

WRAPAROUND PRACTICE ELEMENT:

STRENGTHS, NEEDS, CULTURE, AND VISION DISCOVERY

|From the National WrapAround Initiative: |

|1.3 Facilitate |Service Coordinator meets with the youth/child and family to hear their story; gather their perspective on |

|conversations with family|their individual and collective strengths, needs, elements of culture, and long term goals or vision; and |

|and youth/child |learn about natural and formal supports. Service Coordinator helps family identify potential team members and|

| |asks family to talk about needs and preferences for meeting arrangements (location, time, supports needed |

| |such as child care, translation) |

| |Service Coordinator prepares a summary document. Using the information from the initial conversations with |

| |family members, the Service Coordinator prepares a strengths-based document that summarizes key information |

| |about individual family member strengths and strengths of the family unit, as well as needs, culture, and |

| |vision. The family then reviews and approves the summary. |

|From the Vroon VanDenBerg Skill Sets |

|Explore strengths, |The Service Coordinator listens deeply and asks follow-up questions to understand the youth and family’s |

|needs, culture, and |point of view. |

|vision with child/youth|The Service Coordinator helps the family identify their priority concerns and needs. |

|and family. |The Service Coordinator elicits information about individual and collective strengths of the family and their|

| |social environment across all relevant life domains. |

| |The Service Coordinator elicits information about individual and family culture. |

| |The Service Coordinator identifies potential natural and formal supports of the family. |

| |The Service Coordinator identifies potential barriers to the involvement of natural supports on the child and|

| |family team, e.g., unresolved conflict between family members. |

| |The Service Coordinator asks the youth and family about their hopes and dreams (elicits a long range vision).|

| |The Service Coordinator works with the family and identified team members to complete a functional assessment|

| |of key problem behaviors (maybe should add items on the individual components of the functional assessment). |

| | |

|Service Coordinator |The Service Coordinator completes a written narrative that summarizes the family and youth’s strengths, needs|

|prepares a summary |and culture, and vision. |

|document. |The Service Coordinator reviews the SNCD with the family and edits the narrative to reflect their positive |

| |view of their life and family |

Introduction to Life Domains

We can conceptualize the lives of the families according to universal areas of life called life domains. The life domain framework is a tool with multiple uses. Life domains can be used to facilitate the identification of areas of priority need for a child and family. A Service Coordinator might show the family a list of life domains followed by a brief explanation of each area. The Service Coordinator as a roadmap for the strengths and culture discovery process may use life domains. Inquiring about strengths and culture in each life domain helps ensure that the discovery is comprehensive, i.e., all areas of life are explored. A list of life domains follows. It can be added to or modified to fit the culture of the family or community.

Residence. Where does the family live? What is the neighborhood like? Do the current living arrangements meet the family's needs?

Family. Who is in this family by their definition? Do all family members have appropriate access to each other? What do the members of the family need to stay together or in touch with each other? Are there serious, unmet needs for any family members that impair family functioning?

Social. Do family members have friends and access to their friends? Does this family have the opportunity to socialize with each other? Do individuals socialize outside the family? Do they have any fun? Do they have any way to relax?

Behavioral Emotional. Are any problem behaviors blocking a family member’s chances of having a good life? Does the referred individual have any unmet needs in these areas? Do any other family members have unmet needs in this area? Are there unresolved issues that impede normal interactions within the family or in the community?

Educational/Vocational. What will it take to ensure a viable education for the children, particularly the identified client? Do older children have access to employment opportunities? For what sort of future are they being prepared? Are their rights intact?

Safety. Is everybody in the family safe? Are there dangers to individual family members? Is anybody potentially dangerous to themselves or to the community?

Legal. Are any family members involved in the judicial system, on probation or parole? Do they have representation? Are there issues around custody?

Health. Are healthcare needs met? Does the family have access to specialized medical services they may need?

Spiritual. Are family spiritual needs being met?

Other Possible Areas: Crisis intervention, Pets, Hunting, Cultural, Financial.

The Spiritual Life Domain: Exploring a Family’s Spiritual Life

Often, many professionals have been trained to avoid or minimize discussion about spirituality. Separation of church and state dictates that governments should not control churches in any way. Another aspect of separation of church and state is that governmentally funded services providers must not evangelize or push a family toward any faith community. This helps protect religious freedom, a vital aspect of a free society. However, some helping professionals have interpreted this mandate to mean that we are not allowed to or should not mention spiritual issues with the youth and families we serve.

Spirituality, however, is an important area of life for most of our youth and families as well as a significant source of natural support or potential source of support. Avoiding discussion of a family’s spiritual life can be a significant missed opportunity. This discussion can identify important natural supports as well as lead to a deeper understanding of a family’s culture.

The discussion of spirituality requires that WrapAround Service Coordinators develop specialized skills and a comfort-level in this area in order to be effective. Service Coordinators need to learn specific methods for exploring a family’s spiritual beliefs, connections to the faith community, and/or interest in becoming involved with a faith community.

It is common to see families that have family members with troubling behaviors who have been discouraged from participating in a faith community. Often, a family involved in the WrapAround process that wants to participate in a faith community has not been able to due to embarrassment over a family member’s behavior. Some faith communities are not prepared to handle individuals with complex needs and problematic behaviors. As a result, the WrapAround process can provide needed support to a family and its faith community so their relationship can develop fully.

The following are typical initial questions to ask in the discovery of this life domain:

• What does a typical Sunday morning look like in their family (or other day that a family may have for attendance at their faith community).

• Are you or is your family part of a faith community?

• Have you or your family ever been part of a faith community?

If the family indicates that they are part of a faith community or want to be and have not been due to family member behaviors, then the Service Coordinator can proceed with additional questions:

• How does your family express their spirituality?

• Is your family new to this faith community?

• What do you like about your faith community?

• Are there special persons in your faith community who mean a great deal to you or your family? What do they do to support your family?

• What do you feel you need to be able to participate in your faith community again?

• Is there someone from your faith community who you would like on the child and family team?

A goal about reconnection or strengthening of an existing connection to a faith community may become a target of the WrapAround plan. However, separation of church and state means that as Service Coordinators, we have to be cautious about not ever pushing our own religious agenda or beliefs. No matter what your personal spiritual beliefs, you would not say “Don’t you really think being part of a faith community would help your family?” You would not say “I would like to invite you to attend my church.”

The Strengths, Needs, Culture, and Vision Discovery Event

Strengths, needs, culture, and vision discovery is both an event and an ongoing process. It is an ongoing process in that the WrapAround Service Coordinator will continue to discover family strengths and important aspects of family culture until the Service Coordinator is no longer working directly with the family. Strengths, needs, culture, and vision discovery is an

event in that it is a planned meeting(s) and information gathering process with the family, and others that know the family well and who care.

There are three overall goals of the strengths, needs, culture, and vision discovery interview:

1. Identify strengths, assets, and resources that may be mobilized to meet family needs for support.

2. Learn about and understand the culture of the family, so the eventual WrapAround plan “looks like” and “feels like” the family, i.e., is culturally competent and therefore more likely to be a plan the youth and family will buy into and participate in.

3. Record child and family needs. Ask about and establish a long range vision. Ask about and set short term goals that are steps toward the vision. Needs are immediate areas of focus that are identified by the family to address the goals and long range vision. For example “I want Victoria to be at home, but I need to be able to manage her behavior.”

The strengths, needs, culture, and vision discovery is the most important step of the WrapAround process. A superficial strengths discovery leaves the Service Coordinator and child and family team with deficits but not the understanding of strengths and culture to develop a truly individualized plan and therefore a deficit-based plan. Deficit-based plans have likely already been tried without positive outcomes. A comprehensive strengths, needs, culture, and vision discovery will permit the plan to include strength-based options for meeting the needs of the youth and family that reflect the culture of the family. Such a discovery supports a plan that is highly individualized. In other words, the plan is “one of a kind” and is designed to fit the unique needs of the family rather than the approach typical of traditional service systems where a family is offered only available categorical service with little regard for fit.

The strengths, needs, culture, and vision discovery (SNCVD) is an ongoing process that has a developmental patter, which includes:

⇨ Engaging the family in the rationales and process of the SNCVD

⇨ Identifying other people who might participate in the process

⇨ Gathering information across life domains on the strengths and culture of the family

⇨ Developing a long range vision

⇨ Identifying priority needs related to the long range vision

⇨ Developing short term goals

⇨ Developing a draft SNCVD document

⇨ Reviewing and revising the document with the family

⇨ Using the SNCVD to drive the initial stages of the child and family team process and the vision, goals and needs to be addressed

⇨ Continually updating the SNCVD as new information is identified and as conditions change

The SNCVD interview(s) generally takes between one and three hours and may be split between multiple meetings depending on the needs and availability of key family members and other individuals who provide the family with support. The interview is conducted in a safe place of the family’s choosing, at a time convenient to the family.

It is useful whenever possible to encourage as many family members and other individuals who know the child and family well to participate in the strengths, needs and culture discovery interview. Extended family members, friends and neighbors, and other natural supports may all be potential participants in the discovery process. It is always easier to engage individuals outside the immediate family early in the WrapAround process rather than later. However, the family has the final say in determining whom to include in the strengths, needs and culture discovery interview.

The findings of SNCVD are recorded in a narrative format usually not less than two typewritten pages in length. The Service Coordinator provides the written discovery to the family for review in a follow-up meeting. Families often have additional strengths they thought of since the interview and would like added to the discovery. Families check the document for accuracy. We recommend that the written discovery be completed within three business days as the richness of the interview is lost if there is a longer delay.

A family SNCVD interview consists of three parts: the introduction, information gathering and focusing.

The Introduction. During the introduction phase of the culture discovery, the Service Coordinator explains the process of discovery and the rationale for doing this type of interview. This is the time to engage the family in the process. Describing what will be produced (you might show them a training example) and how it will be used to drive the planning process is often helpful. It’s often useful to say as part of the rationale that all families have both strengths and needs, that previous helping persons have probably concentrated too much on needs (deficits), and therefore, the Service Coordinator’s first job is to discover the family’s strengths so there is a balanced understanding of the family. During this engagement phase it is important to carefully consider who should be part of this process. Identifying extended family, members, friends and natural supports at this point can help with a better SNCD and engage these natural supports in the process. Each introduction, however, will need to be tailored to the family being interviewed.

Information Gathering. During the information gathering phase of the strengths, needs and culture discovery, the Service Coordinator begins by asking spontaneous questions about the strengths, preferences, culture, habits, traditions, and family rules, etc. Ideally, the interviewer avoids using a canned list of questions. However, new interviewers may find it useful to consult a list of potential questions as they go through the process. The interviewer asks a question, and then follows up the question with other queries based on the answer given.

The strengths, needs and culture discovery interview requires flexibility and advanced interviewing and engagement skills. For staff with previous experience in interviewing families the process can be rapidly mastered after only a few interviews supported by good coaching. For those with less experience, mastery may require a dozen or more interviews before the subtle aspects of the interviewing process are acquired. For individuals with less interviewing experience, coaching by an experienced WrapAround Service Coordinator will be especially important as a means of providing ongoing feedback.

Many families will find it difficult at first to focus on their strengths. This may be due to the fact they have been trained by previous helping persons to focus only on their deficits. Gentle redirection is required when the family or others move into deficits. Families eventually get “in the strengths groove” and enjoy discussing aspects of their life and relationships not frequently recognized. Once in a while, despite multiple redirects back to strengths, a family will stay stuck on deficits. In these instances, it is likely that insufficient time in deep listening was spent with the family during engagement. One might say, “You know we were planning to discuss your family’s strengths today, but it seems more important that I listen to your concerns now. We can do the strengths discovery another time.” After sufficient engagement has been established, the strengths, needs and culture discovery is rescheduled.

Following are sample annotated questions commonly asked during strengths, needs and culture discovery interviews. Annotations identify each question’s life domain and/or provide additional information about the intent behind the question.

|Sample SNCVD Questions |Life Domain |

|What is your best quality as a parent? What do you like most about your son/daughter? |Family life domain. |

|Does your family belong to any part of the faith community? What do you enjoy about your |Spiritual life domain. |

|faith? | |

|Is your family in the same faith? |Spiritual life domain. |

|Tell me about how you were raised. Can you give me an example of something you learned from|Family life domain. |

|your parents? Are you similar or different as a parent than your parents? In what ways? | |

|Does your family celebrate holidays? Which ones? In what way? |Family life domain – family culture. |

|Do you have people over to your home frequently? |Friend’s life domain. |

|Who were the last three visitors to your home? |Friend’s social domain. |

|Describe for me the pace of how your family operates? Very fast? Slower than most? Do you |Family culture. |

|like it that way? Is this similar to how you were raised? | |

|How do you relax? |Fun/leisure life domain. Family culture. |

|(To the youth) What are your favorite things to do? Why do you like them? |Fun/leisure life domain. |

|Tell me a little about your neighborhood. Does everybody know everybody else’s business or |Residence/neighborhood life domain. |

|are people very private? | |

|I find that most parents have dreams about their youth. What would you like their lives to |Family life domain. Eliciting hopes and dreams. |

|be like at 21 years old? 40? Do you have a long range vision for your family? | |

|What is your favorite time of the day? Year? Why? |Family culture. |

|Who do you call when times are tough? |Identifying social network. |

|When do you have the most enjoyable times with your family? |Fun/leisure life domain. |

|What do you enjoy doing the most with your family? |Fun/leisure life domain. |

|I see from your file you are (Native American; African American; Chinese-American, etc). |Family culture. |

|Could you tell me about how being (Race) has affected you in a positive way? | |

|If you could do anything different with your life, what would it be? |Eliciting hopes and dreams. |

|(To the youth) What do you enjoy the most about school? Who was your best teacher ever? |Educational/vocational life domain. |

|Why? | |

|(To the youth) Who do you sit with during lunch hour at school? |Educational/vocational life domain. Identifying |

| |social network. |

|Do you have any heroes? Why are they your heroes? |Family culture. Social network. |

|Do you have any immediate goals for your family? |Eliciting hopes and dreams. |

|How are you in a crisis? Could you give an example? |Social network. |

|What was your best job ever? Why? Who are you closest to at work? |Educational/vocational life domain. Identifying |

| |social network. |

|Describe your parenting style. |Family life domain. Family culture. |

Needs

Needs are defined by the youth and family since they are experiencing them. Needs can be elicited by asking the youth and family: “What do you need to have a better life?” However, if a youth is in the custody of the state, a caseworker or other representative of the state may also define youth and family needs. Life domains may be used as a tool to categorize and discuss areas need of the youth and family.

Once a youth and family have identified an area of need, it is crucial to find out why the need is important. Two families may have the same need but in exploring the need more deeply it is revealed that they have similar needs for entirely different reasons. Understanding the “why” of the need will permit planning that is competent to the culture of the youth and family.

About Family Culture

What is family culture? Webster’s defines culture as a particular form of civilization, especially the beliefs, customs, arts, and institutions as a society at a given time. Family culture is the unique way that a family forms itself in terms of rules, roles, habits, activities, beliefs, and other areas. The racial or ethnic culture in which a family lives may strongly influence family culture. Other families are no longer tied to cultural norms of their ethnic or racial group. Every family is different, every family has its own culture. Children and youth with complex needs also form a culture on the street as they hook up with street connections.

What is cultural competence in the area of Family Culture? As helping professionals, we are frequently asked to assist families. Often, because we do not learn the unique culture of a family, our interventions effectively ignore how this family operates. We then are sometimes puzzled why the family does not respond to services, or why their buy-in or cooperation is low. Culture is about differences: legitimate, important differences. Cultural competence in the area of family culture occurs when we not only discover what the individual family culture of a family is, but we appreciate the cultural differences of the family. You may find that most people are not used to thinking about culture in terms other than race or ethnicity, and that family culture is a new term for them.

Long Range Vision and Goals

Once a youth and family have identified their priority areas of need based on life domains, the Service Coordinator guides the planning process to long range vision clarification and short term goal setting.

A long range vision is where the family wants to be at the end of the formal part of the WrapAround process, or at some point in the future. The short term goals are the baby steps that the family and the child and family team will take that leads them to the fulfillment of the long term vision. Long range vision or short term goals can be identified and modified at any point in the WrapAround process. For example, a parent’s or youth’s long range vision and short term goals may be identified by the Service Coordinator and preliminarily discussed with the family during engagement or during the strengths, needs and culture discovery. The long range vision and the related short term goals are further prioritized, clarified and defined in measurable terms during the initial child and family team meeting. Modification of the long term vision and short term goals is then an ongoing process until the transition out of the WrapAround process.

A long range vision statement can be elicited by asking, “Life would be better in the housing domain if…?” The family might respond by saying, “Life would be better if we had a bigger home.” This is a long range vision that could be the focus of a WrapAround plan. We recommend a follow-up question, “Why do you need a bigger home?” Different families have the same long range vision but as a result of very different needs. One family might want a bigger home because they have other children in relative care and could have them home if they had more room. Being together is an important family value. Another family with the same vision may want a bigger home so each family member can have more privacy.

Here is another example. During engagement, Carmen and Robert, the parents of an aggressive 16 year old said that they want their son to turn 18 without having physically hurt another person, or having been hurt himself. This is a long range vision. During the WrapAround plan development step, the team worked out short term goals that would move Robert in the direction of the long term vision. One of these short term goals was for Robert to learn communication skills that would help him stay out of the verbal conflicts that have led him into physical alterations. The child and family team can then develop strengths-based culturally competent options to reach this reasonable and measurable short-term goal.

Activity:

Practicing Strengths, Needs, Culture, and Vision Discovery

Pairs Exercise

Instructions: In new pairs as assigned, decide who will be Kelly and who will be Angela. The Kelly role should do an in-depth discovery of Angela’s strengths, needs, vision, and culture. Note: In actual WrapAround practice, the Service Coordinator would likely do this step with Phillip and other family members present, or even Irma, the case worker or other potential team members present.

Setting the Stage for the role play:

⇨ Kelly’s task is to lead a SNCVD session, which would have occurred two days after the successful unsupervised visit. During that visit, the crisis plan was implemented successfully. Kelly’s task is to do a thorough SNCVD, covering all life domains, especially those relating to family, safety, and medical.

⇨ Kelly should take detailed notes.

⇨ Freeze the role play when a SNCVD question seems to really work or not work very well. Both in the pair should record it below. Then, continue the role play

⇨ We will discuss questions that worked well or needed changing, during large group debriefing of the exercise.

Example of a Good Discovery:

The Hardy Family Strengths, Needs, Culture, and Vision Discovery

⇨ Angela wants Victoria back at home and wants the two girls to grow up to be more successful than she has been. When asked the miracle question she wants a future where the girls are with her and Phillip, they are both doing well in school and not having any more problems than other people.

⇨ The family lives in a two bedroom ranch style house. Angela reports the house has enough room for them but there is not enough storage and it is hard to keep clutter under control. They have a fenced backyard for the dog.

⇨ Angela has been willing to take significant steps (separating from Larry, and following through with family preservation and parenting classes) to try to keep her family together.

⇨ The family unit has been more stable for over a year. Phillip adds a calming influence for Angela. The number of angry outbursts has decreased and there is more of an order to day to day life.

⇨ There are safety concerns in that Angela has a history of violence but is doing much better now. Victoria has caused some concerns about safety with her violent behavior.

⇨ Phillip was in foster care for several years as a youth and has a strong commitment for Victoria to come back home and not be in foster care. At first she seemed to see him as an outsider and was very concerned that her dad was gone and blamed her mom and Phillip. She seems to be warming up to him.

⇨ Angela and Phillip have had steady employment for at least a year. She works as a nursing aide at a local nursing home and he works for a general contractor as a laborer.

⇨ Angela and Phillip are proud that they work. They believe people should earn their own way. Angela wants to have a better paying job.

⇨ Angela has had a lot of tension with her mother (Mary) and sister (Jeannie) and they went through a period of not talking for several years. This was the period in which she was with Larry and they were drinking heavily. They were very concerned about losing the first children and then about Victoria and Elizabeth. Since Larry has left the relationship has begun to improve. During the last two years they have provided support and resources for Angela as she has tried to turn her life around.

⇨ The Hardy family (mother and two sisters) believe in taking care of each other as long as the other person is trying to live up to family values. Angela, Phillip and the girls have good health. They have a medical home and dentist and have regular check-ups.

⇨ Angela and Phillip do not attend church and do not want to at this time. Phillip has never been involved in religious activity. Mary is a practicing Catholic.

⇨ Mary (Angela and Jeannie’s mother) has had a lot of challenges in her life. Her husband abused her physically for a number of years but she stuck by him because of the girls. When they were teenagers she left him and has been able to create a new life for herself. She has more friends now and is active in her church and local garden club.

⇨ Mary wants the best for Angela and her girls and believes they can succeed. She knows she was able to overcome a lot and believes Angela has the same strengths. She is willing to provide support but does not feel capable or willing to provide a long term residential placement for Victoria.

⇨ Jeannie has developed a positive relationship with both of the girls and they like to go to Aunt Jeannie’s. She is willing to provide some respite, although she is not willing to let Victoria stay for an extended period of time because of conflicts with her daughter and son.

⇨ Victoria enjoys doing art projects and seems to have a natural flair for it. She enjoys painting and other arts and crafts activities. Angela also enjoys doing these things and some of the best times they have had have been when they have done arts and crafts activities together.

⇨ Jeannie has a friend at work that teaches art classes on the side. She thinks this person has the patience and skills to be successful with Victoria and might be willing to work with Victoria and Angela.

⇨ Angela is very interested in human services issues and wants to get more of an education to help other people who have problems likes hers. She worked for three years to complete an associate’s degree and is the first member of her family to complete any advanced schooling. Going to school creates extra stress for her but she was able to get through it. Her mother and sister are proud of her accomplishment and helped with some childcare to help her succeed.

⇨ Phillip is dedicated to making this work for Angela and the girls. At first both girls were wary of him but now Elizabeth likes to do activities with him. They go to the park or walk the dog around the neighborhood most evenings.

⇨ Elizabeth would like to have more friends. Opportunities to have girls over to play have been limited by Victoria’s behavior and Angela’s school schedule. She likes to play with her cousins but would like more time with other kids.

⇨ Linda (the Head start teacher) has had Victoria for two years and really wants to see her succeed. She has worked with the mental health consultant to do a functional assessment of the aggressive behaviors. They identified days when Victoria was tired and not taking her medication as two antecedents. She tried to talk to Angela about this but it did not go well. She care enough to call Irma for help

⇨ Victoria is good at many of the activities at Head start but gets frustrated easily which is a barrier at times. Angela says that the girls doing well at school is important to her but sometimes believes the teacher blames her for Victoria’s behavior.

⇨ Bob (mental health therapist) reports that Victoria has done better when she has taken medication on a regular basis. He feels that some of the problems related to observing the domestic violence in the home and then the loss of her Dad. He believes she can learn to control her behavior and do well in school. He has consulted with Will (Angela’s therapist) they have worked together and are willing to work with the team.

⇨ Will (Angela’s therapist) reports that Angela has made a lot of progress. She has developed some personal goals and followed through on them. She has worked through the AA degree and is not binge drinking any more. She has begun to examine her anger outbursts and recognizes many of the triggers. She is taking steps to control these.

⇨ Angela states that her long-range vision is to get Victoria home and have her do well at home and school.

Her two short-term goals are:

• To have 3 unsupervised home visits without violent outbursts

• To meet the CPS plan goals for Angela to get parent education to better understand and react to Victoria’s behavior.

Angela selected the following team:

Phillip – boyfriend

Jeannie – sister

Irma – CPS worker

Mariana – WrapAround family support partner

Delta – Foster mom

Bob – Victoria’s therapist

Kelly – Service Coordinator

Solution Defining

These questions help family members define who, what, why, where, when and how of the need and needed solution. It helps to identify the nature of the need and how the need is related to the long range vision. WrapAround is not about solving all needs for families but helping them to address the ones that are barriers to meeting the long rang envision of the WrapAround process.

▪ Under what circumstances is this likely to occur?

▪ When this happens (Victoria loses her temper and becomes aggressive) what do you do?

▪ What are the positives for you in continuing to stay in this relationship?

▪ Who else is concerned about this problem in your family?

▪ What would have to be different for you to not be afraid?

▪ How often did it happen last week?

▪ Who was there when it happened?

▪ Where were you when Victoria had her temper tantrum?

Past Successes

Through the interview process, you can focus on the family’s past successes, that is, when the need was met well enough. It is empowering to the family member to realize that there was a period in his or her life when he or she was more successful than he or she feels at this moment. Examples of questions include:

▪ It’s not easy to raise two children on your own. How did you do it?

▪ After having been through what you’ve been through, how did you find enough strength to keep pushing on?

▪ What do you need to do so that you’ll feel good about yourself and in control of your life again?

▪ What would it take for you to bring back the confidence you had when you were in high school?

▪ What has and is making it possible for you to cope?

Exception Finding Questions

In solution-focused interviewing, exceptions are times when, problems could have happened but did not. You and the family need to examine who did what, when, where, and how so that the need was not present. Essentially, you are trying to discover how the patterns around the needs are different, especially what is different when the need does not occur. In addition, problematic behaviors usually happen only within certain physical, relational or social contexts. It is important to find out in detail what happens when the person does not have the problem. That information can be used to identify the abilities or resources the family uses successfully in one setting. Those strengths/abilities could be transferred to another setting. Example of exception finding questions include:

▪ I can see you have every reason to be depressed. When do you suppose you get a little bit less depressed?

▪ How would you say you are different when you are a little bit less depressed?

▪ When you force yourself to get out of bed and walk the kids to school, what do you suppose your children will notice different about you?

▪ What would it take to force you to get up in the morning more often?

▪ You are saying that you didn’t drink for five days last week. How did you do it?

▪ Tell me what is different for you at those times when you don’t lose control.

▪ How do you explain to yourself that the problem doesn’t happen at those times?

▪ What would have to happen for you to do it more often?

▪ When the problem is solved, how do you think your relationship with your daughter would be different? What will you be doing then that you are not doing now?

Miracle Questions

The miracle question literally asks families to disregard their current needs and for a moment imagine what their lives would be like in a successful future. It creates a vivid image or vision of what life will be like when the need is solved and the family member(s) can see some hope that life can be different. The question is:

▪ Suppose one night there is a miracle while you were sleeping and the problem that brought you to child protective services is solved. Since you are sleeping you don’t know the miracle has happened or that the problem is solved. What do you suppose you will notice that is different the next morning and will tell you that the problem is solved? Follow up questions include:

▪ If the miracle happened, what would be the first thing you would notice?

▪ What would your spouse notice different about you?

▪ If you were to take these steps, what would you notice different around your house?

Minor miracle questions also help family members to look at a more hopeful future. It helps you and them to envision positive outcomes that can become part of the change process... These questions include:

▪ If you had three wishes, what would they be?

▪ If you had a magic wand and could grant you one thing that would solve the problem/meet the need that your family is now facing what would you wish for?

▪ If you could paint a picture for me of what your family would be like if all this were solved, what would that picture look like?

Scaling Questions

Scaling questions are an interesting way to make complex features of a person’s life more concrete and accessible for both the family member and the child protection worker. Scaling questions can be used to assess self-esteem, self-confidence, investment in change, prioritization of problems, perception of hopefulness, etc. They usually take the form of asking the person to give a number from 1-10 that best represent where the family member is at some specific point. Ten is the positive end of the scale, so higher numbers are equated with more positive outcomes or experiences. Examples of scaling questions include:

▪ On a scale of 1-10, with 10 meaning you have every confidence that this problem can be solved and 1 means no confidence at all, where would you put yourself today?

▪ On the same scale, how hopeful are you that this problem can be solved?

▪ What would be different in your life when you move up just one step?

▪ You can use scaling questions to assess client motivation to change.

▪ On a scale of 1-10, how much would you say you are willing to work to solve the problem?

▪ If the client gives a low answer you could ask, what do you suppose your husband would say you need to do to move up one point on the scale?

A Roadmap for the Strengths, Needs, Culture, and Vision Discovery

Comprehensive Strengths. The discovery interview should address youth and family strengths, assets and resources in most or all of the following life domains:

Family Social/Friends Residence/Neighborhood

Financial Vocational Education

Fun Legal Medical

Spiritual Other…

Family Culture. The Service Coordinator needs to learn about the youth and family’s culture. Some examples of family culture follow:

Dress Language Habits

Rituals Rules Assumptions/Beliefs

Preferences Ways

Long Range Vision. The discovery identifies the long term vision for the family.

Needs. The discovery identifies the youth and family needs.

Goals. The discovery identifies “baby steps” toward the long range vision.

Potential Child and Family Team Members. The SNCVD identifies the individuals who may participate on the child and family team, i.e., the 4 – 8 people who know the youth and family well and who care.

The Closing. During the closing part of the interview, the Service Coordinator thanks the participants, and reminds them that they will be asked to review the written narrative of the discovery after it is compiled. Set a time with the youth and family when they can review the written discovery. Finish the interview by discussing potential child and family team members who might be invited to participate in the next step of the WrapAround process.

Identifying, Developing and Engaging Natural Supports

One of the primary values of the WrapAround process is the identification and involvement of natural supports on the youth and family’s child and family team. Natural supports of the youth and family might include: extended family, friends, neighbors, or colleagues at work. We believe a good WrapAround plan is composed of not more than 25% formal services and supports (things that cost money) and 75% natural supports (things that don’t cost money).

Ideal Mix of Natural Supports and Formal Services in a WrapAround Plan[pic]

Brokers of Natural Supports and Resources

An important role of the WrapAround Service Coordinator is development of natural supports and resources. It will be from community development efforts of this type that surrogate supports are identified for participation on child and family teams when families are bereft of such supports. Natural systems may also contribute “hard goods” such as clothing or a bicycle, or emergency financial support when youth and families have needs of such support.

The faith community is an important natural partner in supporting youth and families in the WrapAround process. The faith community brokers as many as 75-80% of the natural resources in most communities. There are many other natural system partners with whom relationships may be developed.

Common brokers of natural supports in communities include:

• faith community

• Service clubs (Kiwanis, Elks, Masonic Temples, Optimists, Daughters of the American Revolution, etc.)

• community centers and organizations (Jewish Community Centers, YMCA, Urban League, etc.)

• Veterans clubs or groups (Veterans of Foreign Wars, etc.)

• business groups (professional organizations, chamber of commerce)

• ethic clubs (Italian club)

• senior organizations and centers

• and dozens of others…

Natural Supports on Child and Family Teams: Questions and Answers

What if a family has no natural resources to be on the team?

It may be that a family has no local natural supports due to having recently moved. However, the vast majority of the time that a family says they have no one to be on the child and family team, what they are really saying is that they do not trust you enough to reveal who “their people” are. In these situations, the WrapAround Service Coordinator should be persistent in looking for natural resources while taking the time to build a relationship with the family.

What if the family prefers not to have natural supports on the team?

Start with their preference and comfort level. There are many legitimate reasons why a family may prefer not to have natural supports on their team, including privacy preferences and family culture. However, it is vital that the WrapAround staff work to inform the family that they are risking having no one left for support once the professionals on the team go away. Typically we revisit this issue frequently with the family over the first few months of participation in the WrapAround process in order to address their concerns about having natural supports on the team and to encourage broader team participation.

What if most of our families in the WrapAround process have no natural team members?

We have found that this situation indicates a need for supervisory level evaluation of staff training. It is typical that 10-15% of families may prefer not to have anyone else on their team except professionals. However, if it is substantially more than that percentage, there may be a need to address how families are being asked who will be on their team. We often find that staff may see inclusion of natural team members as secondary to other treatment issues (Remember, family, faith and friends are what humans use most to get through life crises!), or that staff are worried that the team will be too big or take too much time to manage.

WRAPAROUND TEAM FORMATION

|From the National WrapAround Initiative: |

|1.4 Engage other team members |Solicit participation/orient team members. Service Coordinator, together with team embers if they so choose, |

|Goal: To gain the |approaches potential team members identified by the youth and family. Service Coordinator describes the |

|participation of team members |WrapAround process and clarifies the potential role and responsibilities of this person on the team. Service |

|who care about and can aid the|Coordinator asks the potential team members if they will participate. If so, the Service Coordinator talks |

|youth/child and family, and to|with them briefly to learn their perspectives on the family’s strengths and needs, and to learn about their |

|set the stage for their active|needs and preferences for the meeting. |

|and collaborative | |

|participation on the team in a| |

|manner consistent with the | |

|WrapAround principles | |

|From the VroonVanDenBerg Skill Sets: |

| Solicit participation |Service Coordinator contacts potential team members to identify their strengths and orient them to the WrapAround |

|orient team members. |process. |

| |Service Coordinator elicits concerns, hopes and goals of potential team members for their participation in the |

| |team process. |

| |Service Coordinator identifies areas of potential conflict and problem solves these. |

The SNCVD process identifies the individuals who provide support to the youth and family. These are the individuals who care and know the family well. Friends, extended family, neighbors, individuals from the faith community, teachers, social workers, therapists, and others may be identified by the family as important sources of support or potential support.

The members of the child and family team are drawn from this group of support persons. The family is empowered to select the individuals they want to participate on the team, unless the child is in custody. We refer to this as “family voice and choice”. If they are in state or tribal custody, the system shares voice and choice with the family at whatever level is appropriate given safety of the child and community. Targets for team composition are as follows: four to eight individuals who care and know the family well; not more than 50% professional service providers. Take care to individualize this issue: as one wise colleague once said, “At the beginning, a child and family team might be the WrapAround Service Coordinator and the Mom.”

Some families who have lost their natural supports may only have professionals on their team to start. For small teams and teams composed mostly of professionals, the Service Coordinator’s goal is to increase the team size and recruit more natural supports over time, so targets are gradually approximated. Experience has shown that teams composed primarily of professionals can serve to discourage family voice and choice, and the resulting plan may be primarily existing services which may not reflect the individual needs of the child and family. Small teams may not possess sufficient resources to support the youth and family overtime without getting burned out.

If families have children in the custody of the state, i.e., youth that are child welfare involved or on probation, child welfare case workers and/or probation officers are almost always on the team. This is an exception to the value of maximizing family voice and choice. If the state has legal/parental authority, a representative of the state must be on the team. All team members should know the family since strangers are unlikely to know the strengths, culture and values of the family.

Service Coordinators are trained to see the team as a dynamic process in which some members may be added or subtracted as the needs of child and family change over time. If the team has been correctly configured, many or all of the team members are the same culture as the family. Therefore, the eventual plan is likely to be culturally competent.

Child and Family Teams

Functions. Developing WrapAround plans; planning for crisis; supporting the implementation of the plan; accessing natural and formal supports/resources; monitoring services; inspiring unconditional care; long term support of family long after formal services are gone.

Members. Parents, children (if they can handle it), and the 4-8 people who know the family best. If you don't know the strengths and needs of the family, you can't be on the child and family team.

Who Determines Who Is On The Team. The Service Coordinator works with the family to see who knows them best.

Meeting Places. Wherever it is comfortable for the family.

Meeting Time. Set the meeting times at the convenience of the team members who have the most difficult schedules.

Meeting Frequency. At first, the team meets every week. Within four weeks or so, the meetings drop to once a month. Later, the team meets quarterly or as needed.

Child and Family Team Meeting Preparation

|From the National WrapAround Initiative: |

|1.5 Make necessary |Arrange meeting logistics. Service Coordinator integrates information gathered from all sources to arrange |

|meeting arrangements |meeting time and location and to assure the availability of necessary supports or adaptations such as |

| |translators or child care. Meeting time and location should be accessible and comfortable, especially for the |

| |family but also for other team members. Service Coordinator prepares materials – including the document |

| |summarizing family individual and collective strengths, and their needs, culture, and vision – to be distributed|

| |to team members. |

|From Vroon VanDenBerg Skill Sets: |

| |Service Coordinator arranges for needed supports for the family and youth to assure their participation and |

|Arrange meeting |comfort in the team process. |

|logistics. |Service Coordinator makes arrangements for team meeting time and location that are sensitive to the needs of the |

| |family and team. |

| |The Service Coordinator prepares needed documents for distribution at the team meeting. |

| |The Service Coordinator works with the family and team to develop an agenda and timelines for each meeting |

WrapAround is a team process but if all of the work of the process is done within team meetings team members will be less engaged in the process for two reasons. First, the meetings will be too long and working through too many personal conflicts during these meetings will prevent team cohesiveness from forming. WrapAround is based on the philosophy that frequent successes build momentum. For these reasons the WrapAround Service Coordinator and family do some of the work to prepare for team meetings outside of meetings. This includes completing drafts of the strengths, needs, culture, and vision discovery, and functional assessment. These are brought to the team and the team makes decisions about how to proceed and commitments to support the plan. WrapAround Service Coordinators should contact potential child and family team members to explain the WrapAround process and the specific reason they are needed on the team. Sometimes individuals may be on the team but not at the meeting due to scheduling conflicts. In these instances, the WrapAround Service Coordinator may discuss the child and family team agenda in advance with this person to get their input, which the Service Coordinator will then share in the meeting on the person’s behalf. The Service Coordinator will then call the person after the meeting to advise them of the outcome.

Additional Solution-focused Questions

Often family members have more solutions available than they realize. Solution-focused questions are questions the helper can frame to help the family member direct attention to useful answers that will move them forward. These questions can empower family members to find their own solutions. Here are some additional examples of solution-focused questions:

▪ How do you keep making it work for you and your family?

▪ What are some of your family’s strengths that can be used to accomplish the plan/steps/changes?

▪ What needs to change to make you feel safe?

▪ Under what conditions have you been able to make your family safe?

▪ On a scale of 1-10, how important do you think this decision is to your family?

▪ What solutions have worked for you in the past regarding ______________?

▪ When was the last time _________________ didn’t happen?

▪ Who else is interested in helping your family change?

▪ How have you been able to change/accomplish things that are important to your before?

▪ What is the role of other family members in helping your family change?

▪ What do you get from continuing this behavior?

▪ How will this step/service help you?

▪ What is happening in your family that keeps you from doing this?

▪ What would need to be done to help you do this?

▪ What do you want right now?

▪ What would make this possible?

▪ What have you tried that has not worked?

▪ If you could change one thing, what would it be?

▪ When are you and your son able to have a good time together?

▪ When things are going well, what is your family doing?

▪ Describe the last good day you had together.

▪ On a scale of 1-10, how important is it that _________?

▪ What are the common issues that unite your family?

▪ What do you see as the things that stop you?

▪ What could help you be more in control and less vulnerable?

▪ How can you increase the involvement of each family member in the plan?

▪ On a scale of 1-10, how difficult is it for you to maintain the behavioral plan for Tim?

▪ Where do you feel stuck?

▪ How do you describe what it feels like to be stuck?

▪ What is one step that you could take to move forward?

▪ What is the most important to address for you?

▪ When and under what circumstances is this behavior likely to occur?

▪ How and under what circumstances is this behavior likely to occur?

▪ With whom is this behavior likely to occur?

▪ What are some ways you can disrupt/change the patterns of behavior that aren’t working for you?

▪ What are some ways that the positive/effective behaviors could increase?

▪ What motivates you?

▪ What causes you to be uncomfortable?

▪ What new understandings/experiences would help you to change?

▪ What are you concerned about that could go wrong if you follow this course of action?

▪ What are you afraid might happen?

▪ If you were to wake up tomorrow and find that this problem was gone, how would you and your family be different?

▪ If you were to wake up tomorrow and find that this problem was gone, what do you think would have happened to make it go away?

▪ When was the last time you expected this __________ to happen and it didn’t?

Tips on the Art of WrapAround Planning

Right People at The Meeting. Don’t have a meeting if the right people can’t be there. Don’t ever have a meeting without the family. Ever.

Organization Skills. The team has a lot to do and not much time. Being hyper -organized is crucial.

Facilitating Team Behavior. Unfortunately, few of us were trained to be team members. Many of us were trained to run the show. Therefore, team behavior must be taught, modeled, shaped, and rewarded by the Service Coordinator.

Meeting Management: Ground Rules

Service Coordinators don’t have to set ground rules for every team. If the team shows the skills and personality that promise effective work together without a lot of artificial structure, they do not need additional ground rules. However, if the Service Coordinator thinks that it is possible that the team may blame and shame or fight for control, it is vital to set ground rules up front.

Ground rules may vary based on the composition of the team. The Service Coordinator should identify ground rules that they think would be helpful based on the unique composition of the team, and the culture of the family. For example, if the parents of the child have a history of fighting over custody, a ground rule may include no insults or yelling. If expectations are set early in the process and a strength-based approach is maintained, the chances are greater that the initial planning meeting will be successful.

Typical ground rules might include:

• Everyone is to focus on the positive.

• The Service Coordinator expects team members to help monitor the discussion to assure that it stays strength-based.

• The team is expected to avoid professional jargon.

• People are expected to share their good ideas.

• No one is to blame for what has happened in the past: the purpose of the meeting is to work together in the future.

Managing Challenging Behavior in Child and Family Team Meetings

Sometimes team members present challenging behavior that is an impediment to achieving the goals of the WrapAround process. These behaviors must be addressed swiftly and effectively in order to develop and maintain an effective child and family culture. An angry professional can derail the entire process, or an out-of-control parent may stop any progress from occurring.

What follows are some of the most common challenging behaviors as well as potential solutions:

1. Late team members. Use the teaming process to discuss what should be the team commitment around being on time.

2. Team members with other agendas. It is common for a team member to come into the meeting with a hidden agenda, such as get the team to agree to placement, or to close the case. The Service Coordinator must actively and proactively deal with this issue by “sniffing” out those who may come loaded with hidden agendas. Call them in advance and ask what they want out of the meeting, then put their issue on the table at the start of the meeting, and ask the team if they want to deal with that today. Or, ask them to hold their agenda because it conflicts with the direction of the team.

3. Team members who never learned to work as a team. Unfortunately, some team members truly are not team members – they are used to making decisions on their own and want to do what they wish. They may feel that the team process is an impediment to getting their job done. The Service Coordinator must deal with this through lots of team building. For example, start slow and get a success or two under the team’s belt. Perhaps take an extra meeting just to let team members introduce themselves and share personal stories. In addition, the Service Coordinator has to individually and group coach these types of team members.

4. Team members who don’t listen. Unfortunately, some team members just never learned to listen to others. This may cause others to feel a sense of disrespect. Check to see if this is a cultural issue. You may ask the non-listening team member to take notes on what others are saying. You may represent or advocate for the points made by those who were not listened to.

5. Team members who are burned out. It is common for high caseload individuals to be a bit “fried” on the job. The Service Coordinator should sympathize, but also keep the meetings brief, and build a phone or email relationship with the “fried” ones. Cultivate a relationship with them. Honor their strengths, expertise and achievements.

6. Team members who don’t understand family voice and choice. Unfortunately, family members are often given voice and choice up to the point that the professional disagrees with the family. In the early stages of WrapAround in a community, many professionals who don’t understand the value of family voice and choice will be shocked to discover that family driven means, well, family driven. The Service Coordinator is the person who stands up for the values of the WrapAround process.

7. Team members who are angry with the family. These team members most often will attempt to belittle the family or lecture them about their responsibilities. These team members can be very destructive to the process. The Service Coordinator should not allow blaming and shaming, ever. Stop the meeting, stop the presses, and just stop the abuse! The Service Coordinator must keep the environment safe for all team members.

Common Planning Problems

Planning Meetings that are too long. Planning sessions that take more than one hour may produce resistance on the part of child and family team members. It is not realistic to assume that any team member can take several hours to attend a child and family team planning meeting. We have also learned (the hard way) that an overly long planning meeting can cause system staff to go back to their units and complain about you – thereby losing not only one staff but the entire unit!

Targeting too Many Needs at Once. In the early days of WrapAround, we used to develop ten pound plans that went through each life domain and produced dozens of goals. We used to draw bubbles on flip charts and link eighteen different life needs to options. However, we found that these methods of planning, which emulated the work done when developing a comprehensive treatment plan, overwhelmed staff and discouraged families.

Human needs don’t truly come all at once. We have a need, that need gets met, then that met need causes all the unmet needs to change, and so on. For example, a family may have primary needs of housing and friends for the kids. When the housing need gets met and the family is now near more kids, the need for friends has diminished too. Therefore, we try to prioritize life domain needs and resulting goals and needs, and meet the most important goals first. We know once a very important short term goal is met, then all other goals are going to change. There is a domino effect. Don’t work on more than two short term goals at one time, or the long range vision may never be met.

WRAPAROUND PRACTICE ELEMENTS:

|From the National WrapAround Initiative |

|Develop an initial plan of care: |Determine ground rules. Service Coordinator guides team in a discussion of basic ground rules, elicits |

|Goal: To create an initial plan of|additional ground rules important to team members and facilitates discussion of how these will operate |

|care using a high quality team |during team meetings. At a minimum, this discussion should address legal and ethical issues – |

|process that elicits multiple |including confidentiality, mandatory reporting, and other legal requirements – and how to create a safe|

|perspectives and builds trust and |and blame-free environment for youth/family and all team members. Ground rules are recorded in team |

|shared vision among team members, |documentation and distributed to team members. |

|while also being consistent with | |

|the WrapAround process | |

| |Describe and document strengths. Service Coordinator presents strengths from the summary document |

| |prepared during phase 1, and elicits feedback and additional strengths, including strengths of team |

| |members and community |

| |Create team mission. Service Coordinator review’s youth and family’s vision and leads the team in |

| |setting a team mission introducing idea that this is the overarching goal that will guide the team |

| |through phases and ultimately, through transition from formal WrapAround. |

CHILD AND FAMILY TEAM MEETING FACILITATION AND

WRAPAROUND PLAN DEVELOPMENT

| |

|2.1 a. Determine ground rules. |The Service Coordinator elicits and develops consensus on team ground rules and a decision-making |

| |process that maximizes family and youth voice and choice and minimizes blame. |

| |The Service Coordinator discuses and develops a consensus on confidentiality at the team level. |

|2.1 b. Describe and document |The team reviews, discusses and adds to the strengths, needs and culture narrative at the team meeting.|

|strengths. |The Service Coordinator establishes a strengths-based team culture. |

|2.1 c. Create team mission. |The Service Coordinator reviews the youth and family’s concerns, needs, family vision, and develops |

| |consensus on the mission of the team. |

|2.1 d. Describe and prioritize |The team reviews and prioritizes youth and family concerns and needs. |

|needs/goals. |The team develops specific goals that address priority concerns and needs. |

|. |The team sets measurable short term objectives for each goal. |

| |The team defines methods and frequency for evaluating progress toward these desired outcomes. |

|2.1 e. Select strategies and |The Service Coordinator manages the meeting efficiently and effectively so that the planned agenda is |

|assign action steps. |completed during the CFT meeting. |

| |For each objective, the team brainstorms multiple natural and formal support options. |

| |The team selects the options that have the best chance for success and save the others as potential |

| |future options. |

| |The team defines a specific action plan that specifies who will do what, when, and how often for each |

| |objective. |

Team Mission

Once a youth and family have identified their priority areas of need based on life domains, the Service Coordinator guides the planning process to long range vision clarification and short term goal setting.

A long range vision is where the family wants to be at the end of the formal part of the WrapAround process, or at some point in the future. The short term goals are the baby steps that the family and the child and family team will take that leads them to the fulfillment of the long term vision. Long range vision or short term goals can be identified and modified at any point in the WrapAround process. For example, a parent’s or youth’s long range vision and short term goals may be identified by the Service Coordinator and preliminarily discussed with the family during engagement or during the strengths, needs and culture discovery. The long range vision and the related short term goals are further prioritized, clarified and defined in measurable terms during the initial child and family team meeting. Modification of the long term vision and short term goals is then an ongoing process until the transition out of the WrapAround process.

A long range vision statement can be elicited by asking, “Life would be better in the housing domain if…?” The family might respond by saying, “Life would be better if we had a bigger home.” This is a long range vision that could be the focus of a WrapAround plan. We recommend a follow-up question, “Why do you need a bigger home?” Different families have the same long range vision but as a result of very different needs. One family might want a bigger home because they have other children in relative care and could have them home if they had more room. Being together is an important family value. Another family with the same vision may want a bigger home so each family member can have more privacy.

Here is another example. During engagement, Carmen and Robert, the parents of an aggressive 16 year old said that they want their son to turn 18 without having physically hurt another person, or having been hurt himself. This is a long range vision. During the WrapAround plan development step, the team worked out short term goals that would move Robert in the direction of the long term vision. One of these short term goals was for Robert to learn communication skills that would help him stay out of the verbal conflicts that have led him into physical alterations. The child and family team can then develop strengths-based culturally competent options to reach this reasonable and measurable short term goal.

Needs

Needs are defined by the youth and family since they are experiencing them. Needs can be elicited by asking the youth and family: “What do you need to have a better life?” However, if a youth is in the custody of the state, a caseworker or other representative of the state may also define youth and family needs. Life domains may be used as a tool to categorize and discuss areas need of the youth and family.

Once a youth and family have identified an area of need, it is crucial to find out why the need is important. Two families my have the same need but in exploring the need more deeply it is revealed that they have similar needs for entirely different reasons. Understanding the “why” of the need will permit planning that is competent to the culture of the youth and family.

Options or Strategies

Once needs, mission and goals have been established, the task of the child and family team is to brainstorm strength-based options for achieving the short term goals. The Service Coordinator should share the strengths, needs and culture discovery narrative with all members of the child and family team. This is crucial since, for some participants, they may have a predominantly deficit-based view of the youth and family. The strengths, needs and culture discovery helps them see youth and family strengths as well as their needs. Sharing the strengths, needs and culture discovery at the child and family team meeting also establishes the value of the strengths-based approach, so it is incorporated into the culture of the child and family team. Ground rules help establish child and family team culture as does the way the Service Coordinator manages the logistics and other details of the process. Options to advance the youth and family toward achieving their long range vision and short term goals should be drawn from strengths and culture of the family and community. The needs, long range vision, short term goals, and specific options constitute the WrapAround plan.

WrapAround Planning

The following is an example of a WrapAround plan, which was done for a family named the Jones Family, for a five year old person who was in foster care due to a fragile home situation and the child’s violence and property destruction. Note how the short term goals are backed up by the use of “baby step” short term goals, which are met by strengths-based culturally competent options.

|WrapAround Plan For: Sam Jones |

|Team Present: Sam(target youth), Sally (custodial grandmother), Heri (CPS), Beverly (aunt), Debbie (friend), Kevin (friend), Craig |

|(Service Coordinator) |

|Areas of Need |

|X Family __ Social/Friends X Residence/Neighborhood __ Financial __ Vocational __ Educational __ Fun __ Legal __ Medical __ |

|Spiritual __ Other: |

|Long Range Vision: Both Sally and Sam want Sam to return home from foster care. |

|First Short Term Goal |Options – Specify who and when. |

|Sam will have three |1. Sally needs weekend respite in order to avoid escalating power struggles with Sam. Kevin will take Sam to a|

|successful weekend home |wild life petting zoo next Saturday during Sam’s weekend home visit. He will pick-up Sam at 10:30 am and will |

|visits. A successful home |return him at 2:30 pm. He will also take Sam on Saturday during his next two home visits – specific times and |

|visit is one without a |activity yet to be determined. |

|crisis episode, i.e., no | |

|violence, property |2. Beverly will provide unplanned respite if Sally decides she needs an extra break. Beverly will provide up |

|destruction or running away.|to 2 hours respite. Sally will call Beverly on her cell phone if she is not home to take the respite request. |

| |If Beverly cannot provide unplanned respite, Reverend Anderson has agreed to be an alternate unplanned respite |

| |resource. He will provide up to 3 hours during the evenings and can be reached by cell phone. |

|Comments/Notes: |

|We will hold the next child and family team meeting on the same day, time, and location next week. |

Note: this form is designed for training purposes only. It does not constitute a recommendation about how your system will document WrapAround plans. Specific forms for your agency/system must be individualized to meet local strengths, needs, culture and specific system requirements.

WRAPAROUND PRACTICE ELEMENT: CRISIS PLANNING

|From the National WrapAround Initiative |

|Develop crisis/safety plan. |Determine potential serious |Assisting the family and youth and team to identify most likely crises.|

|GOAL: To identify potential problems |risks. |Prioritize crises based on severity and likeliness of occurrence. |

|and crises, prioritize according to | |Eliciting detailed information about each priority crisis area. |

|seriousness and likelihood of | | |

|occurrence, and create an effective and| | |

|well-specified crisis prevention and | | |

|response plan that is consistent with | | |

|the WrapAround principles. | | |

| |Create crisis/safety plan. |Brainstorming multiple natural and formal support options that may |

| | |prevent the crisis from occurring. |

| | |Evaluating and supporting the family and youth to select best options |

| | |for preventing the crisis or safety situation. |

| | |Developing actions steps to be followed should the crisis and safety |

| | |situation occur that specify who will do what, when, and how often. |

|Complete necessary documentation and |Complete documentation and |Developing team consensus and schedule for future meetings. |

|logistics. |logistics. |Producing and distributing written WrapAround and crisis and safety |

| | |plans. |

|From Vroon VanDenBerg Skill Sets |

|2.2 a. Determine potential |The Service Coordinator assists the team to identify the most likely crises. |

|serious risks. |The Service Coordinator facilitates the completion of a functional assessment for the identified crisis(es) |

|2.2 b. Create crisis/safety |The Service Coordinator and the team use the functional assessment of the potential crisis or safety issue as a |

|plan. |base for the work of the team in creating the crisis or safety plan |

| |The Service Coordinator leads a brainstorming process to identify multiple natural and formal support options that|

| |may prevent the crisis from occurring. |

| |The written crisis plan is distributed to all CFT members and specifies each team member’s role in carrying out |

| |the plan. |

| |The crisis plan is updated as needed: after each occurrence of the crisis, when a new crisis is predicted, and in |

| |advance of major transitions for the youth or family. |

|2.3 a. Complete documentation|The Service Coordinator ensures the CFT meets frequently enough to complete the development of comprehensive |

|and logistics. |WrapAround and crisis or safety plans. |

| |The Service Coordinator produces, maintains and distributes written WrapAround and crisis and safety plans that |

| |tie to the team’s mission. |

Every youth and family in the WrapAround process needs a crisis plan. Crisis is a part of life for all human beings. Crisis for youth and families involved in the WrapAround process is frequently a way of life. Youth and families involved in the WrapAround process have complex needs and challenging behaviors and therefore have very high levels of risk of serious crisis. Therefore, it makes sense to plan for needs and behaviors that may lead to crisis proactively.

After the initial child and family team meeting wherein the initial WrapAround plan is developed, the Service Coordinator’s next task is to lead the child and family team through the crisis planning process. Crisis plans address the question, “What might go wrong and divert the child and family team from implementing the WrapAround plan?”

Outside of the WrapAround process, in traditional service systems, crisis “plans” are made during the height of the crisis when emotions are running high. As a result, poor decisions are often made in the “heat of the moment”. Proactive planning for crisis ensures that plans are designed when the child and family team is capable of its most creative and best thinking.

A meeting to develop a crisis plan should be held within three days of the initial child and family team meeting. On some occasions, such as when a youth is returning home from a temporary out of home placement, a crisis plan may need to be developed before the WrapAround plan. The steps of the WrapAround process are non-linear and need to be managed based on the immediate needs of the youth and family.

Crisis planning is most often conducted with the youth and immediate family. Others from the child and family team may participate in this process based on the family’s preference and their availability and expertise. If crisis plans are made by a subset of the child and family team, the plan is always shared with the full team at the next scheduled meeting of the entire team.

Phases of Crisis

Crises have phase or stages. A crisis has a beginning phase when an event, behavior or sequence of behaviors initiates the crisis cycle. A crisis has a middle or peak phase when there is rapid escalation of emotional intensity, fear and risk. A crisis has an end phase when there is rapid de-escalation of emotional intensity and fear. The level of risk subsides substantially during the end phase. The phases of a crisis often repeat in a circular pattern, i.e., once the crisis has reached the end phase, a triggering event may initiate the crisis cycle again. The Service Coordinator’s job is to identify the circumstances and interactions that are the component parts (sequences) in each of the phases of the crisis.

Crisis Planning Steps

An effective crisis plan begins with a detailed functional assessment of the predicted crisis. Once a functional assessment is done, we find the following simple three step process for crisis planning is useful. The steps are:

1. Predict. The Service Coordinator begins by assisting the youth and family in predicting the worst case scenario. This is the point in the WrapAround process where we are not strengths-based. As a child and family team, we sit in a circle and ask, “What is the worst thing that could happen?”

2. Prevent. The Service Coordinator uses his or her knowledge of the youth and family’s unique crisis process (derived from the functional assessment) as the foundation for developing options drawn from community and family strengths to prevent the events, behaviors and sequences of behavior that lead to the crisis from happening.

3. Plan (for managing the crisis). The Service Coordinator partners with the youth and family to develop steps for the management of the crisis if the crisis occurs despite our prevention efforts. Who calls who? Who does what? When? Where? Clearly defined steps crafted in advance that detail how to manage the crisis when it occurs makes it much easier to handle, and will often lessen the intensity of the crisis as well as risk level of the crisis. The plan for managing the crisis provides direction to family members when they are least able to problem solve due to the emotional affects of the crisis when it is occurring. The youth and family know what to do and what not to do during the crisis.

|Summary of Functional Assessment for Victoria |

|Step |Question/Answer |

|1 |Clearly describe the behavior: Victoria becomes physically violent hitting, kicking, and /or biting other people. |

|2 |What happens before the behavior occurs (triggers and antecedent behaviors)? Are there times/situations where the behavior does not|

| |occur? Why? |

| |Victoria will be playing with other children and something seems to frustrate her (e.g., it might be that she does something that |

| |does not work, that she does not get her way, or that some one makes fun of her). |

| |When she has not had enough sleep and is showing signs of being tired. |

| |When she misses her medications. |

| |When something has happened with her mother that upsets her. |

| |Before she gets violent she often begins to curse and begins to seem tense. |

| |The behaviors do not seem to happen when she is rested and taking her medications |

|3. |What happens during the behavior? |

| |During the behavior itself Victoria seems to be out of control. She does not listen to others and does not respond to requests |

| |that she normally would. Once she reaches the outburst stage she must work through the outburst and will calm down after about |

| |three to five minutes if nothing further agitates her. The most successful strategies are to separate her from other people in a |

| |safe place. |

|4 |What happens after the behavior occurs? Now when the behaviors occur she requires separation from the group to calm down. After |

| |the behavior all of the previous activities are ended and she either spends some time by herself or resumes a new activity. Before|

| |the development of the safety plan, when she had the episodes at home they would sometimes go off and on with Angela for as long as|

| |two hours. |

|5 |Best guess about why the behavior occurs? She has an explosive disorder in which she responds to frustration (when she is tired or |

| |upset) by having these violent behaviors. They may have been learned watching her mother and dad respond to frustration in their |

| |lives. |

|6 |Select a positive replacement behavior |

| |Victoria will learn to recognize the upcoming behaviors and ask to go to a safe area. |

SAFETY PLANNING

When should safety plans be developed? Safety plans should be developed when there is solid evidence of past unsafe behaviors by one family member toward others or toward themselves that create high risk. Safety plans address the question, “What actions need to be taken to ensure a safe and stable environment for the youth and family?” Safety plans in the WrapAround process will most often address youth who present high risk behavior. However, safety plans may also be developed to protect children from high risk behavior on the part of adult caregivers or other family members.

If a youth has a substantiated history of serious sexual aggression or is clearly identified as a potential danger to community or self, it is critical to develop a safety plan that addresses these risks. Community placement of children who offended against other children or the community, must be done with the highest levels of concern for the safety of the community, the family, and the child.

Safety plans should be developed when community concerns over safety are threatening the chances that a child may remain in their community.

“Better safe than sorry”. If a family member or a professional has a gut level sense that safety is an issue, then a safety plan should be developed after consultation with a professional qualified to determine if a child is a potential or an actual offender.

Who develops safety plans? Ideally, safety plans are developed by the child and family team working with a WrapAround Service Coordinator or another professional, with experience writing safety plans. It is sometimes awkward to include persons who have been responsible for committing high-risk behaviors in the planning session, but it is critical to attempt to have plan ownership by the youth in question. Safety plans are always reviewed by a professional who is qualified in the treatment of children who have offended against others.

What are the characteristics of good safety plans? Good safety plans are both proactive and reactive. In other words, they include a preventive approach to unsafe behaviors or situations, but also include a plan about what to do if the unwanted behavior is attempted or actually occurs. At critical points, adults often do not know what to do. It is important that a good safety plan clearly define roles, responsibilities, and required actions for each individual responsible for implementing the safety plan. The plan should also include a back-up plan should the primary plan fail when the dangerous behavior occurs.

All plans start with a recognition that no plan can prevent 100% of dangerous behavior. But a well-constructed and carefully implemented and monitored safety plan can promote a very safe environment for the youth, the family, and the community.

The Steps of Safety Planning:

Step One: Clearly describe the situation

Step Two: Start with clarifying goals

Step Three: Define inappropriate and appropriate behaviors

Step Four: Establish family and community rules

Step Five: Be proactive about educating siblings and others

Step Six: Plan for community safety

Step Seven: Plan for the 24 hour day

Step Eight: Have a back-up plan

Step Nine: Create a proactive plan for negative community reactions

Step Ten: Support and build the family through teaching healthy alternatives through the WrapAround process

An Example: A Safety Plan for Living with a Child Who Sexually Acts Out Against Young Children

Step One: Clearly describe the situation

Billy is 14 years old. Billy lives with his parents, Susan and Sam, and with his younger brother and sister (ages 8 and 9). Billy has a history of acting out behaviors and problems at school. When Billy was 9 years old, he was sexually molested by a neighbor who was convicted of the crime and imprisoned for 25 years. When Billy was 10, he was found attempting to have sexual intercourse with his younger sister (age 7 at the time). His mother and father arranged treatment for him with a specialist who works with children with sexual acting out behaviors.

Several months after therapy ended, he was found in bed with his sister. He repeatedly exposed himself by coming out of the bathroom partially exposed. His parents were terrified of what he might do, and asked the local child welfare office for help. The worker who assisted the family did home visits and found that Billy engaged in many “grooming” behaviors towards both his younger sister and brother. Out of fear of harm to the siblings, child welfare worked with the court (Judge Bishop), which helped place him in a group home.

After six months in the group home, Billy was ready for discharge. The Judge allowed his release since Billy’s parents were willing to have him come home. They were justifiably concerned about their other children, and the reaction of the community.

The WrapAround worker had been trained in developing safety plans and worked with the family and the child welfare worker (Nevel Jameson) to develop a plan for Billy and his siblings, his parents, and the community.

Here is the finished plan with instructions in italics:

Step Two: Start with clarifying goals

Statement of expectations/goals: Billy will exhibit no sexual behaviors toward the young children living in the house.

Step Three: Define inappropriate and appropriate behaviors

Definition of inappropriate sexual behaviors by Billy:

1. Having the young children sitting on his lap

2. Touching his own genital area in the proximity of the children

3. Sitting or lying on the bed of the children

4. Touching the children except when playing contact games, and particularly not in genital areas, buttocks or in breast areas for girls

5. Talking about sexual matters around the children

6. Showing sexual pictures or drawings to the children

7. Tell stories with sexual connotations to the children

Definition of appropriate sexual behaviors by Billy:

1. Touching his genital areas when he is alone in the privacy of the bathroom or when alone in room

2. Having sexual feelings toward girls his own age or older (Billy was evaluated as being heterosexual)

Step Four: Establish family rules

Family rules for contact between Billy and the children:

1. Billy is never to be alone with the children except in the event of an emergency.

2. Billy is allowed to play with the children in appropriate ways such as card games, Nintendo, or watching television or listening to music. When Billy needs clarification on whether or not a game is appropriate, he will ask Susan or Sam. Billy is not to make these decisions on his own.

3. Susan or Sam will give Billy frequent feedback if they feel that he is beginning to violate rules regarding contact with the children or with inappropriate sexual behaviors.

4. Billy is not ever allowed to play with children from other families without supervision. He is not allowed to enter houses without adult supervision, where other children may be present.

Step Five: Be proactive about educating siblings

A proactive plan to educate children about safety issues:

1. Beth Sampson (therapist at the mental health center) is a certified expert teacher of good touch/bad touch curriculum for young children. She will give the two children extensive lessons in good touch/bad touch.

2. She will give four follow-up refresher sessions at one month intervals.

3. Beth will join the WrapAround child and family team for at least six months and will be available to Nevel Jameson or to the parents as needed.

4. Susan and Sam will do frequent reminders with the children about what they have learned.

Step Six: Plan for community safety

Billy is not allowed to “hang around” the younger children in the neighborhood unless adults are with him. At school, he will not be allowed to play with the younger kids. For the first six months of his plan, one of his parents will drive him to school, escort him inside, and pick him up after school. It may be necessary to hire an aide through WrapAround to supplement parent time as needed.

Step Seven: Plan for the 24 hour day

Plan for night hours:

As 24 hour care is not possible, a motion detector will be placed outside of Billy’s bedroom. He will call to Susan or Sam if he has to go to the bathroom so that they can disable the detector and reset it after he returns to his bedroom. This part of the plan will be in place for at least six months, then evaluated for continued need.

In addition, the children will be trained to scream loudly if any one other than their parents enters their room at night. Each child will be trained in the use of an alarm buzzer mounted at the side of their beds. Practice sessions will be held to help train the kids in the procedure. The materials for the buzzer, and the motion detector can be purchased at Radio Shack.

Step Eight: Have a crisis back-up plan

If Billy should violate the rules of inappropriate sexual behaviors:

Nevel Jameson (child welfare worker) will be notified immediately. Billy will be removed from the home and placed in the Jones shelter while an investigation is completed. If necessary, due to severity of the violation, Billy will be placed in detention for one to three weeks. If the violation involves direct sexual contact with children, Nevel will contact Judge Bishop who will advise the team and recommend action.

Plan if Sam and Susan are not sure if Billy has violated a rule:

They will call Nevel and ask for a clarification and a decision. If Nevel is unavailable, they can call Susan Pierce (child welfare worker) as a back-up.

Nevel will conduct home visits and monitor the safety plan implementation. This will be done at least every month for the first six months, and then quarterly thereafter.

Step Nine: Create a proactive plan for negative community reactions

If a community member believes that Billy does not belong in the community and begins to cause concerns to be developed by other community members:

Nevel will obtain a copy of the court order allowing Billy to live at home. If Billy reports harassment or if community members complain to Susan or Sam, they will refer the complainant to Nevel, who has court and family permission to show them the order. If for any reason Billy’s safety is in question, Sam or Susan will increase supervision of Billy outside of the home. The police will be called if necessary.

Step Ten: Support and build the family through teaching healthy alternatives

Plan for using the WrapAround process to support Billy and his family, and to teach him positive alternatives to deviant behaviors:

The parents will help create a plan that addresses Billy’s needs and those of the other family members. Family members’ strengths will be used to develop the plan. For example, since Billy is quite athletic, sports may be included in the plan as an outlet for him. The plan will reflect other family members interests similarly, and include them as methods of creating opportunities for family engagement in positive activity.

Remember: monitor, document, and ask for help if needed.

It is important to note that Nevel and the WrapAround resource coordinator are planning to hold weekly monitoring meetings for the first six weeks of the plan, and then to have meetings at least once a month for one year. Documentation duties will be assigned, and careful daily records kept by Susan and Sam. They will send the records to Nevel weekly. Sam and Susan will ask for help when they feel that they need it.

The Steps of Safety Planning Reviewed:

Step One: Clearly describe the situation

Step Two: Start with clarifying goals

Step Three: Define inappropriate and appropriate behaviors

Step Four: Establish family and community rules

Step Five: Be proactive about educating siblings and others

Step Six: Plan for community safety

Step Seven: Plan for the 24 hour day

Step Eight: Have a back-up plan

Step Nine: Create a proactive plan for negative community reactions

Step Ten: Support and build the family through teaching healthy alternatives

Immediate Crisis Stabilization Plan, WrapAround Plan, Crisis Plan: How do you keep these straight?

| |Purpose |Risk Level |Who Gets One |

|Immediate Crisis |Mobilizes needed resources to |May address behavior or situations at|Only families with immediate |

|Stabilization Plan |address immediate crisis or safety|all risk levels – mild, moderate, |stabilization needs. |

| |concerns identified at engagement.|high. Highest risk behavior requires | |

| |This is typically an interim plan.|companion safety plan. | |

|WrapAround Plan |Support youth and family to meet |May address very complex needs and |Every family in the WrapAround process. |

| |priority areas of need, so that |all levels of risk (mild, moderate, | |

| |stabilization, crisis and safety |high). Highest risk behavior requires| |

| |plans are no longer necessary. |companion safety plan. | |

|Crisis Plan |Proactively addresses areas of |Behavior that poses mild to moderate |Every family in the WrapAround process. |

| |potential crisis not |risk levels. | |

| |comprehensively addressed in | | |

| |WrapAround plan. | | |

[pic]

WRAPAROUND IMPLEMENTATION

Implementation: Carrying out the Plan

|From the National WrapAround Initiative |

|Implement the WrapAround plan. |Implement action steps for each|Monitoring and supporting team members to complete assigned actions |

|GOAL: To implement the initial plan of |strategy. |steps. |

|care, monitoring completion of action | |Educating providers and other system and community representatives |

|steps and strategies and their success | |about the WrapAround process. |

|in meeting need and achieving outcomes | |Identifying and assisting the family and youth to access necessary |

|in a manner consistent with the | |resources. |

|WrapAround principles. | | |

| |Track progress on action steps.|Tracking completion of action steps according to target timelines for|

| | |completion. |

| | |Understanding why action steps were not completed when this occurs. |

| | |Identifying what support team members need so they can successfully |

| | |complete their assigned task. |

| |Evaluate success of strategies.|Determine if the services and supports defined in the plan and |

| | |implemented through corresponding action steps are meeting priority |

| | |family and youth needs. |

| | |Evaluating progress toward the team’s mission. |

| |Celebrate successes. |Developing plan goals and strategies that ensure the family and youth|

| | |and team experience success. |

| | |Establishing team culture that honors team members for their |

| | |contributions and frequently celebrates successes. |

|Revisit and update the plan. |Consider new strategies as |Brainstorming new options when plan strategies and action steps are |

|GOAL: To use a high quality team |necessary. |not resulting in progress toward established goals. |

|process to ensure that the WrapAround | |Revising the plan so it reflects new strategies and action steps that|

|plan is continually revisited and | |the family and youth think will help meet their needs. |

|updated to respond to the successes of | |Identifying new areas of need and facilitating the reprioritization |

|initial strategies and the need for new| |of needs when necessary. |

|strategies. | |Guiding the team to amend the plan to target newly identified |

| | |priority needs. |

| | |Monitoring so that plan revisions continue to align with the team’s |

| | |mission. |

|Maintain/build team cohesiveness and |Maintain awareness of team |Orienting, preparing and welcoming new team members to the WrapAround|

|trust. |members’ satisfaction and |process. |

|GOAL: To maintain awareness of team |“buy-in”. |Maximizing family and youth voice and choice. |

|members’ satisfaction with and “buy-in”| |Creating and maintaining team safety (“No blame. No shame.”) |

|to the process, and take steps to | |Assessing team member satisfaction with the team process. |

|maintain or build team cohesiveness and| |Encouraging participation. |

|trust. | | |

| |Address issues of team |Implementing changes to the team’s process to improve satisfaction |

| |cohesiveness and trust. |and effectiveness. |

| | |Building and maintaining consensus. |

| | |Resolving conflict. |

| | |Continuing education and actualization of WrapAround principles. |

|Complete necessary documentation and |Complete documentation and |Producing, maintaining and distributing written plan updates. |

|logistics. |logistics. |Scheduling and planning for ongoing meetings. |

|From the Vroon VanDenBerg Skill Sets |

|3.1 a. Implement action steps|The Service Coordinator monitors team member’s completion of assigned action steps. |

|for each strategy. |The Service Coordinator supports team members to complete assigned actions steps. |

|3.1 b. Track progress on |The Service Coordinator understands why action steps were not completed and identifies the support team members |

|action steps. |need to successfully complete there assigned task. |

|3.1 c. Evaluate success of |The Service Coordinator evaluates if the services and supports are meeting the priority family and youth needs. |

|strategies. |And making progress toward the team’s mission. |

|3.1. d. Celebrate successes. |The Service Coordinator reviews progress and celebrates successes at each CFT meeting. |

|3.2. a. Consider new |The Service Coordinator revises the plan so it reflects new strategies and action steps that the family and |

|strategies as necessary. |youth think will help meet their needs. |

| |The Service Coordinator periodically has the team review the plan to determine how well it is meeting the team |

| |mission. |

|3.3 a. Maintain awareness of |The Service Coordinator orients new team members to the WrapAround process and their role on the team. |

|team members’ satisfaction |The Service Coordinator supports buy-in to the process for all team members to maintain and build cohesiveness |

|and “buy-in”. |and trust. |

| |The Service Coordinator fosters an environment that maximizes family and youth voice and choice and supports |

| |their increasing control over the WrapAround process. |

| |The Service Coordinator periodically assesses team member satisfaction with the team process and supports a team|

| |culture that honors team members for their contributions. |

|3.3 b. Address issues of team|The Service Coordinator implements changes to the team’s process to improve team satisfaction and effectiveness.|

|cohesiveness and trust. |The Service Coordinator creates and maintains team safety (“No blame. No shame.”) |

| |The Service Coordinator continually works to build and maintain consensus on the goals and plans of the team. |

| |The Service Coordinator actively works to resolve conflicts between team members. |

|3.4 a. Complete documentation|The Service Coordinator produces, maintains and distributes written plans. |

|and logistics. |The Service Coordinator ensures the CFT team meets frequently enough to provide needed support to the youth and |

| |family. |

WrapAround is a team-based process and nurturing the team is of critical importance to the success of the process. Service Coordinators should begin working on building team cohesiveness in the first meetings with each team member and continue throughout this process through transition. The WrapAround Service Coordinator has the responsibility for ensuring that the WrapAround plan is carried out between child and family team members. This doesn’t mean that the Service Coordinator must manage this task alone. He or she might delegate some or all of the tracking functions to someone else on the team. However, the Service Coordinator must then follow the tracking of this person – at least initially.

Options to meet needs and achieve goals that become part of the WrapAround plan indicate specific actions that need to be carried out by child and family team members. This is the “who, what, where, and when” of the plan. Nothing will rob the team of momentum and the child and family of hope more than a significant failure of a child and family team member to follow through with an important element of the plan. Walking into a child and family team meeting and learning that nothing has happened between meetings is disheartening to the team as whole and may cause some team members to rethink their commitment to the team.

The importance of tracking assignment completion is especially important early in the process. Later, the Service Coordinator will have more relationship (and therefore more leverage) with child and family team members and will know the strengths and weaknesses of each team member. The Service Coordinator will know what are realistic commitments by team members and what kinds of commitments are too ambitious. Until then, the Service Coordinator will find it efficient in the long run to invest time between meetings calling team members to nudge them along on their assignments. Gentle reminders and quick a thank you when a task is completed on schedule will shape follow through behavior.

Implementation: Transition

|From the National WrapAround Initiative |

|Plan for cessation of |Create a transition plan. |Identifying needs, services and supports that will continue to need |

|formal WrapAround. | |attention past formal WrapAround. |

|GOAL: To plan a purposeful| |Eliciting additional information about family and youth and team |

|transition out of formal | |strengths and culture for use in the development of the transition |

|WrapAround in a way that | |plan. |

|is consistent with the | |Creating a transition plan to meet continuing needs. |

|WrapAround principles, and| | |

|that supports the youth | | |

|and family in maintaining | | |

|the positive outcomes | | |

|achieved in the WrapAround| | |

|process. | | |

| |Create a post-transition crisis management plan|At this point in transition, youth and family members, together with |

| |Service Coordinator guides the team in creating|their continuing supports, should have acquired skills and knowledge |

| |post-WrapAround crisis management plan, |in how to manage crises. Post-transition crisis management planning |

| |including action steps, specific |should acknowledge and capitalize on this increased knowledge and |

| |responsibilities, and communication protocols. |strengthened support system. This activity will likely include |

| |Planning may include rehearsing responses to |identification of access points and entitlements for formal services |

| |crises and creating linkage to post-WrapAround |that may be used following formal WrapAround. |

| |crisis resources. | |

| |4.1 c. Modify WrapAround process to reflect |Teams may continue to meet using a WrapAround process (or other |

| |transition |process or format) even after formal WrapAround has ended. Should |

| |New members may be added to the team to reflect|teamwork continue, family members and youth, or other supports, will |

| |identified post-transition strategies, |likely take on some or all of the facilitation/coordination |

| |services, and supports. The team discusses |activities. |

| |responses to potential future situations, | |

| |including crises, and negotiates the nature of | |

| |each team member’s post-WrapAround | |

| |participation with the team/family. Formal | |

| |WrapAround team meetings reduce frequency and | |

| |ultimately cease. | |

|4.2. Create a commencement|4.2 a. Document the team’s work |This creates a package of information that can be useful in the |

|GOAL: To ensure that the |Service Coordinator guides team in creating a |future. |

|cessation of formal |document that describes the strengths of the | |

|WrapAround is conducted in|youth/child, family, and team members, and | |

|a way that celebrates |lessons learned about strategies that worked | |

|successes and frames |well and those that did not work so well. Team | |

|transition proactively and|participates in preparing/reviewing necessary | |

|positively |final reports (e.g. to court or participating | |

| |providers, where necessary) | |

| |4.2 b. Celebrate success |This activity may be considered optional. Youth/child and family |

| |Service Coordinator encourages team to create |should feel that they are ready to transition from formal WrapAround,|

| |and/or participate in a culturally appropriate |and it is important that “graduation” is not constructed by systems |

| |“commencement” celebration that is meaningful |primarily as a way to get families out of services. |

| |to the youth/child, family, and team, and that | |

| |recognizes their accomplishments. | |

|4.3. Follow-up with the |4.3 a. Check in with family |The check-in procedure can be done impersonally (e.g. through |

|family |Service Coordinator leads team in creating a |questionnaires) or through contact initiated at agreed-upon intervals|

|GOAL: To ensure that the |procedure for checking in with the youth and |either by the youth or family, or by another team member. |

|family is continuing to |family periodically after commencement. If new | |

|experience success |needs have emerged that require a formal | |

|post-WrapAround and to |response, Service Coordinator and/or other team| |

|provide support if |members may aid the family in accessing | |

|necessary |appropriate services, possibly including a | |

| |reconvening of the WrapAround team. | |

|From the Vroon VanDenBerg Skill Sets |

|4.1 a. Create a transition |The Service Coordinator and CFT anticipate major transitions and update the SNCD to address these emerging |

|plan. |needs. |

| |The Service Coordinator helps the team identify the needs that will continue to need attention past formal |

| |WrapAround. |

| |The Service Coordinator leads the team in creating transition plans to address major transitions including needs|

| |for support after formal WrapAround. |

|4.1 b. Create a post-transition|The Service Coordinator guides the team in creating post-WrapAround crisis management plan, including action |

|crisis management plan. |steps, specific responsibilities, and communication protocols. |

|4.1 c. Modify WrapAround |The Service Coordinator supports the family and team to modify the WrapAround process that will be used after |

|process to reflect transition. |the Service Coordinator is gone. |

|4.2 a. Document the team’s |Service Coordinator guides the team in creating a document that describes the strengths of the youth, family, |

|work. |and team members, and lessons learned from the team planning process (what strategies worked – which didn’t). |

| |Team participates in preparing and reviewing necessary final reports (e.g. to court or participating providers, |

| |where necessary) |

|4.2 b. Celebrate success. |Service Coordinator encourages team to create and/or participate in a culturally appropriate “commencement” |

| |celebration that is meaningful to the youth and child, family, and team that recognizes their accomplishments. |

|4.3 a. Check in with family. |Service Coordinator leads the team in creating a procedure for checking in with the youth and family |

| |periodically after commencement. If new needs have emerged that require a formal response, the Service |

| |Coordinator and/or other team members may aid the family in accessing appropriate services including a |

| |reconvening of the WrapAround team. |

Another implementation responsibility of the WrapAround Service Coordinator is tracking progress toward goals through data and other “evidence”. If a goal for a child is successful attendance at school (as measured by an absence of disruptive behaviors), the WrapAround Service Coordinator needs to ensure data on how many successful days the child has is consistently gathered and shared at the child and family team meeting. This is how the team will know, objectively, whether progress is being made toward goal completion. If the data does not show progress over time toward the goal, then the plan needs to be adapted and readapted until progress is reflected by new data.

The WrapAround Service Coordinator is responsible for monitoring progress and facilitating plan modification when progress is not evident. Lack of progress and lack of follow through on assignments to child and family team members may reflect that certain options are not sufficiently individualized or competent to the culture of the child and family. Whatever the reason for options not resulting in progress, the WrapAround Service Coordinator uses a feedback model of change, (i.e., keep trying new options until something works). This is in contrast to the traditional western model of change that is reflected in the old adage: “If at first you don’t succeed, try, try again.” The WrapAround adage is: “If at first you don’t succeed, try something different.”

Tracking plan implementation (i.e., Have options been carried out as planned?) and plan impact toward goal attainment is dependent on WrapAround plans that are measurable. We use quantitative measures (things that can be counted) and qualitative measures (less directly measurable things that are measured by sharing thoughts or feelings, with the CFT deciding if the goals are being met).

Example of a Transition Plan

| |Transition Plan for: Date: |

|1. |Anticipated WrapAround Graduation Date: (September 2004) |

| | |

|2. |First Priority Long Range Vision/Outcome: (This should reflect the team’s chosen long range vision written in measurable outcome |

| |terms; such as “Bobbie will successfully graduate pre-school in spring 2004 and start Kindergarten in the fall of 2004”) |

| | |

|3. |Relevant resources and skills already in place: (this section should list strengths that family/child have in place that directly |

| |relate to the long range visions; such as “Bobbie has learned alternative play skills, he is now skilled at controlling his |

| |aggression with peers at school). |

|4. |Resources and skills needed to achieve LRV: (This section should list all resources and skills needed to achieve the LRV; Bobbie’s |

| |parents need to locate support from other parents of kindergarteners who have emotional challenges) |

|5. |Predicted Crisis(es) Post-Wrap Graduation: (This section should list all major predicted crisis issues that the team thinks may come |

| |up after pre-school graduation; Bobbie will stop using his new skills for positive safe plan, and will once again be aggressive with |

| |other kids. His parents will get overwhelmed dealing with him. Do a functional assessment as needed) |

| | |

| | |

|7. |Timelines for Practices, Details about Who, When, Where etc: (list who is responsible for practicing, ideally someone who is on the |

| |natural support side of the team, when and where) |

Activity:

A Transition Plan for Angela

Instructions: Imagine that the WrapAround plan for Angela has been successful thus far and that reunification with Victoria will likely occur. Irma has said that she would like to see Angela further improve her parenting. Both Jeannie and Mariana are working with her on this task. As a small group, discuss what an ideal transition plan would look like for the Hardy Family. Each participant in the pair should fill in the blanks on the transition plan format page. We will debrief this in large group.

| |Transition Plan for Angela’s Family |

|1. |Anticipated WrapAround Graduation Date: |

|2. |First Priority Long Range Vision/Outcome: Reunification of Family |

|3. |Summarize relevant resources and skills already in place, which are leading to the fulfillment of the vision. |

| | |

|4. |Additional resources and skills needed to achieve LRV: |

| | |

|5. |Predicted Crisis(es) Post-Wrap Graduation: (This section should list all major predicted crisis issues that the team thinks may come |

| |up after graduation; |

|6 |Plan for Practicing Crisis Prevention and Response Pre-Graduation: (This section should briefly detail the team’s plan for practicing|

| |the crisis prevention and crisis response while the professional part of the team is still in place) |

| | |

|7. |Timelines for Practices, Details about Who, When, Where etc: (list who is responsible for practicing, ideally someone who is on the |

| |natural support side of the team, when and where) |

| | |

-----------------------

75% Natural Supports

25% Formal Services

(E.g., Counseling, Parent Aide, Etc.)

Point where crisis “plans” are often made.

High

Intensity

Preferred Crisis Planning Point

Low

Time

Beginning Phase

Middle/Peak Phase

Ending Phase

WrapAround

Plan

Crisis Plan

Plans Are Interdependent

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